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Current HIV Research

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ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Research Article

Serum Interleukin-6 and Weight Loss in Antiretroviral-naïve and Antiretroviral-treated Patients with HIV/AIDS: Relationships and Predictors

Author(s): Tewogbade Adeoye Adedeji*, Nife Olamide Adedeji, Abiodun Kofoworola Ajeigbe, Olufemi Samuel Smith, Olusola Akanni Jeje, Michael Bimbo Fawale, Abiodun Olabamiji Ajose, Simeon Adelani Adebisi, Adeyinka Abdulrasak Akande and Bashiru Adekunle Okesina

Volume 20, Issue 6, 2022

Published on: 02 November, 2022

Page: [441 - 456] Pages: 16

DOI: 10.2174/1570162X20666220901085926

Price: $65

Abstract

Background: Cachexia is usually associated with elevated serum interleukin-6 (IL6) as it stimulates the breakdown of muscle proteins and promotes wasting.

Objective: A case-control study to evaluate the relationship between weight loss, facial fat loss, and IL-6 in antiretroviral-naïve and treated participants living with HIV/AIDS.

Methods: IL-6 was assayed by High performance liquid chromatography (HPLC) in 97 in consecutive newly diagnosed antiretroviral-naive (ART-naïve) people living with HIV/AIDS (age ≥18 years); and 118 consecutive, age-matched participants currently on Highly Active Antiretroviral Therapy (HAART), using age as a criterion. In the treated group, 78 (66.7%) subjects were on zidovudine, lamivudine with nevirapine (Z+L+N); 27(23.1%) on tenofovir, lamivudine with emtricitabine (T+L+E); 5(4.3%) on zidovudine, lamivudine with emtricitabine (Z+L+E); 4(3.4%) on zidovudine, lamivudine with tenofovir (Z+L+T); 2(1.7%) on lamivudine, tenofovir with nevirapine (L+T+N); 1(0.9%) on tenofovir, zidovudine, emtricitabine (Z+T+E).

Results: A total of 215 participants: 97 ART-naive and 118 HAART-treated, age-matched subjects (40.3±9.6 versus 42.7±10.20years, p=0.08). The mean IL-6 was significantly higher in naïve than treated (0.69±0.04 versus 0.66±0.04 pg/ml, p =0.002). In all, 73 subjects experienced weight loss, 56(76.7%) naive, 17(23.3%) treated, p <0.0001, with significantly higher IL-6 in those with weight loss (0.69±0.05 versus 0.67±0.05pg/ml, p= 0.047). Fifty-eight (27.0%) subjects experienced facial fat loss, 49 (84.5%) naïve, and 9 (15.5%) treated, p <0.0001, with significantly higher IL-6 in those with facial fat loss (0.7 ± 0.05 versus 0.67±0.05pg/ml, p= 0.0001). Negative correlation exists between IL-6 and CD4+ count (r=-0.141, p=0.041). In logistic regression, independent predictors of weight loss include: IL-6 (Adjusted Odds Ratio, aOR 1.3, 95%CI 0·1–2·6, p=0.047); HIV duration (aOR 11.6, p <0.0001); AIDS-defining illness (aOR 3.5, p <0.0001); CD4+ count (aOR 3.2, p=0.004); HAART status (aOR 2.7, p<0.0001).

Conclusion: HIV infection is associated with elevation of serum interleukin-6, which likely contributes to weight and facial fat loss among the treatment-naïve participants; while HAART is associated with suppressed IL-6 levels, thereby ameliorating weight and facial fat loss. Inverse relationship exists between serum IL-6 and CD4+ count; serum IL-6 could differentiate between mild- to moderate and severe immunosuppressive states.

Keywords: Antiretroviral-naïve, Antiretroviral-treated, HIV/AIDS, Facial fat loss, Interleukin 6, Weight loss

Graphical Abstract

[1]
Nixon DE, Landay AL. Biomarkers of immune dysfunction in HIV. Curr Opin HIV AIDS 2010; 5(6): 498-503.
[http://dx.doi.org/10.1097/COH.0b013e32833ed6f4] [PMID: 20978393]
[2]
Schroff RW, Gottlieb MS, Prince HE, Chai LL, Fahey JL. Immunological studies of homosexual men with immunodeficiency and Kaposi’s sarcoma. Clin Immunol Immunopathol 1983; 27(3): 300-14.
[http://dx.doi.org/10.1016/0090-1229(83)90083-1] [PMID: 6603314]
[3]
Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med 1983; 309(8): 453-8.
[http://dx.doi.org/10.1056/NEJM198308253090803] [PMID: 6224088]
[4]
Martínez MO, Crabb E, Mitsuyasu RT, Fahey JL, Giorgi JV. Infection with the Human Immunodeficiency Virus (HIV) is associated with an in vivo increase in B lymphocyte activation and immaturity. J Immunol 1987; 138(11): 3720-4.
[PMID: 2953790]
[5]
Birx DL, Redfield RR, Tencer K, Fowler A, Burke DS, Tosato G. Induction of interleukin-6 during human immunodeficiency virus infection. Blood 1990; 76(11): 2303-10.
[http://dx.doi.org/10.1182/blood.V76.11.2303.2303] [PMID: 2257304]
[6]
Breen EC, Rezai AR, Nakajima K, et al. Infection with HIV is associated with elevated IL-6 levels and production. J Immunol 1990; 144(2): 480-4.
[PMID: 2295799]
[7]
Schnittman SM, Lane HC, Higgins SE, Folks T, Fauci AS. Direct polyclonal activation of human B lymphocytes by the acquired immune deficiency syndrome virus. Science 1986; 233(4768): 1084-6.
[http://dx.doi.org/10.1126/science.3016902] [PMID: 3016902]
[8]
Breen EC, Van Der Meijden M, Cumberland W, Kishimoto T, Detels R, Martínez MO. The development of AIDS-associated Burkitt’s/small noncleaved cell lymphoma is preceded by elevated serum levels of interleukin 6. Clin Immunol 1999; 92(3): 293-9.
[http://dx.doi.org/10.1006/clim.1999.4760] [PMID: 10479534]
[9]
Baker J, Ayenew W, Quick H, et al. High-density lipoprotein particles and markers of inflammation and thrombotic activity in patients with untreated HIV infection. J Infect Dis 2010; 201(2): 285-92.
[http://dx.doi.org/10.1086/649560] [PMID: 19954384]
[10]
Funderburg NT, Mayne E, Sieg SF, et al. Increased tissue factor expression on circulating monocytes in chronic HIV infection: Relationship to in vivo coagulation and immune activation. Blood 2010; 115(2): 161-7.
[http://dx.doi.org/10.1182/blood-2009-03-210179] [PMID: 19828697]
[11]
Neuhaus J, Jacobs DR Jr, Baker JV, et al. Markers of inflammation, coagulation, and renal function are elevated in adults with HIV infection. J Infect Dis 2010; 201(12): 1788-95.
[http://dx.doi.org/10.1086/652749] [PMID: 20446848]
[12]
Elgert KD. Immunology: Understanding the Immune System. (2nd ed.), New York: Wiley-Liss 1996.
[13]
Seymour GJ, Salvage NW, Walsh LJ. Immunology: An Introduction for the Health Sciences. New York: McGraw Hill 1995.
[14]
Kishimoto T. The biology of interleukin-6. Blood 1989; 74(1): 1-10.
[http://dx.doi.org/10.1182/blood.V74.1.1.1] [PMID: 2473791]
[15]
Kishimoto T. Interleukin-6: Discovery of a pleiotropic cytokine. Arthritis Res Ther 2006; 8: S2.
[http://dx.doi.org/10.1186/ar1916] [PMID: 16899106]
[16]
Wallenius V, Wallenius K, Ahrén B, et al. Interleukin-6-deficient mice develop mature-onset obesity. Nat Med 2002; 8(1): 75-9.
[http://dx.doi.org/10.1038/nm0102-75] [PMID: 11786910]
[17]
Yeh SS, Schuster MW. Geriatric cachexia: The role of cytokines. Am J Clin Nutr 1999; 70(2): 183-97.
[http://dx.doi.org/10.1093/ajcn.70.2.183] [PMID: 10426694]
[18]
Goodman MN. Interleukin-6 induces skeletal muscle protein breakdown in rats. Proc Soc Exp Biol Med 1994; 205(2): 182-5.
[http://dx.doi.org/10.3181/00379727-205-43695] [PMID: 8108469]
[19]
Strassmann G, Jacob CO, Evans R, Beall D, Fong M. Mechanisms of experimental cancer cachexia. Interaction between mononuclear phagocytes and colon-26 carcinoma and its relevance to IL-6-mediated cancer cachexia. J Immunol 1992; 148(11): 3674-8.
[PMID: 1534101]
[20]
Stenvinkel P, Barany P, Heimbürger O, Pecoits FR, Lindholm B. Mortality, malnutrition, and atherosclerosis in ESRD: What is the role of interleukin-6? Kidney Int Suppl 2002; 61(80): 103-8.
[http://dx.doi.org/10.1046/j.1523-1755.61.s80.19.x] [PMID: 11982823]
[21]
Grunfeld C, Zhao C, Fuller J, et al. Endotoxin and cytokines induce expression of leptin, the ob gene product, in hamsters. J Clin Invest 1996; 97(9): 2152-7.
[http://dx.doi.org/10.1172/JCI118653] [PMID: 8621806]
[22]
Pecoits FR, Nordfors L, Heimbürger O, et al. Soluble leptin receptors and serum leptin in end-stage renal disease: Relationship with inflam-mation and body composition. Eur J Clin Invest 2002; 32(11): 811-7.
[http://dx.doi.org/10.1046/j.1365-2362.2002.01063.x] [PMID: 12423321]
[23]
Don BR, Rosales LM, Levine NW, Mitch W, Kaysen GA. Leptin is a negative acute phase protein in chronic hemodialysis patients. Kidney Int 2001; 59(3): 1114-20.
[http://dx.doi.org/10.1046/j.1523-1755.2001.0590031114.x] [PMID: 11231368]
[24]
Papanicolaou DA, Wilder RL, Manolagas SC, Chrousos GP. The pathophysiologic roles of interleukin-6 in human disease. Ann Intern Med 1998; 128(2): 127-37.
[http://dx.doi.org/10.7326/0003-4819-128-2-199801150-00009] [PMID: 9441573]
[25]
Dallmeier D, Larson MG, Wang N, Fontes JD, Benjamin EJ, Fox CS. Addition of inflammatory biomarkers did not improve diabetes prediction in the community: The framingham heart study. J Am Heart Assoc 2012; 1(4): e000869.
[http://dx.doi.org/10.1161/JAHA.112.000869] [PMID: 23130155]
[26]
Araoye MO. Subject Selection. In: Research Methodology with statistics for Health and Social Sciences. (1st Edition.). Nathadex Publishers 2004; pp. 118-9.
[27]
Kenneth G, Castro MD, John W, et al. Revised classification system for HIV infection and expanded AIDS surveillance case definition for adolescent and adults. MMWR Recomm Rep 1993; 42(RR-17): 1-19.
[28]
Alecu M, Geleriu L, Coman G, Gălăţescu L. The interleukin-1, interleukin-2, interleukin-6 and tumour necrosis factor alpha serological levels in localised and systemic sclerosis. Rom J Intern Med 1998; 36(3-4): 251-9.
[PMID: 10822522]
[29]
Marino A, Giotta N. Advanced access publication. Nephrol Dial Transplant 2008; 23: 1460.
[http://dx.doi.org/10.1093/ndt/gfm856] [PMID: 18065786]
[30]
Ullum H, Diamant M, Victor J, et al. Increased circulating levels of interleukin-6 in HIV-seropositive subjects. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 13(1): 93-4.
[http://dx.doi.org/10.1097/00042560-199609000-00013] [PMID: 8797691]
[31]
Poli G, Fauci AS. Role of cytokines in the pathogenesis of human immunodeficiency virus infection. In: Human cytokines and their role in health and human disease. Cambridge, MA: Blackwell 1995; pp. 421-50.
[32]
Pluda JM, Venzon DJ, Tosato G, et al. Parameters affecting the development of non-Hodgkin’s lymphoma in patients with severe human immunodeficiency virus infection receiving antiretroviral therapy. J Clin Oncol 1993; 11(6): 1099-107.
[http://dx.doi.org/10.1200/JCO.1993.11.6.1099] [PMID: 8099121]
[33]
Nkinda L, Patel K, Njuguna B, et al. C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania. BMC Endocr Disord 2019; 19(1): 77-83.
[http://dx.doi.org/10.1186/s12902-019-0407-y] [PMID: 31331321]
[34]
Borges AH, O’Connor JL, Phillips AN, et al. Interleukin 6 is a stronger predictor of clinical events than high-sensitivity C-reactive protein or D-dimer during HIV infection. J Infect Dis 2016; 214(3): 408-16.
[http://dx.doi.org/10.1093/infdis/jiw173] [PMID: 27132283]
[35]
Kuller LH, Tracy R, Belloso W, et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med 2008; 5(10): e203.
[http://dx.doi.org/10.1371/journal.pmed.0050203] [PMID: 18942885]
[36]
Rodger AJ, Fox Z, Lundgren JD, et al. Activation and coagulation biomarkers are independent predictors of the development of opportunistic disease in patients with HIV infection. J Infect Dis 2009; 200(6): 973-83.
[http://dx.doi.org/10.1086/605447] [PMID: 19678756]
[37]
Friis H. Micronutrients and infections: An introduction: Micronutrients and HIV infection. Boca Raton: CRC Press 2001; pp. 1-21.
[38]
Ullrich R, Zeitz M, Heise W, L’age M, Höffken G, Riecken EO. Small intestinal structure and function in patients infected with Human Im-munodeficiency Virus (HIV): Evidence for HIV-induced enteropathy. Ann Intern Med 1989; 111(1): 15-21.
[http://dx.doi.org/10.7326/0003-4819-111-1-15] [PMID: 2500046]
[39]
Regidor DL, Detels R, Breen EC, et al. Effect of highly active antiretroviral therapy on biomarkers of B-lymphocyte activation and inflammation. AIDS 2011; 25(3): 303-14.
[http://dx.doi.org/10.1097/QAD.0b013e32834273ad] [PMID: 21192231]
[40]
Grunfeld C, Saag M, Cofrancesco J Jr, et al. Regional adipose tissue measured by MRI over 5 years in HIV-infected and control participants indicates persistence of HIV-associated lipoatrophy. AIDS 2010; 24(11): 1717-26.
[http://dx.doi.org/10.1097/QAD.0b013e32833ac7a2] [PMID: 20502316]
[41]
Jacobson DL, Knox T, Spiegelman D, Skinner S, Gorbach S, Wanke C. Prevalence of, evolution of, and risk factors for fat atrophy and fat deposition in a cohort of HIV-infected men and women. Clin Infect Dis 2005; 40(12): 1837-45.
[http://dx.doi.org/10.1086/430379] [PMID: 15909274]
[42]
Shlay JC, Sharma S, Peng G, Gibert CL, Grunfeld C. The effect of individual antiretroviral drugs on body composition in HIV-infected persons initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 51(3): 298-304.
[http://dx.doi.org/10.1097/QAI.0b013e3181aa1308] [PMID: 19412117]
[43]
Shlay JC, Bartsch G, Peng G, et al. Long-term body composition and metabolic changes in antiretroviral naive persons randomized to protease inhibitor-, nonnucleoside reverse transcriptase inhibitor-, or protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-based strategy. J Acquir Immune Defic Syndr 2007; 44(5): 506-17.
[http://dx.doi.org/10.1097/QAI.0b013e31804216cf] [PMID: 17325603]
[44]
McComsey GA, Kitch D, Sax PE, et al. Peripheral and central fat changes in subjects randomized to abacavir-lamivudine or tenofoviremtricitabine with atazanavir-ritonavir or efavirenz: ACTG Study A5224s. Clin Infect Dis 2011; 53: 185-96.
[http://dx.doi.org/10.1093/cid/cir324] [PMID: 21690627]
[45]
Kim RJ, Wilson CG, Wabitsch M, Lazar MA, Steppan CM. HIV protease inhibitor-specific alterations in human adipocyte differentiation and metabolism. Obesity 2006; 14(6): 994-1002.
[http://dx.doi.org/10.1038/oby.2006.114] [PMID: 16861604]
[46]
Zhang B, MacNaul K, Szalkowski D, Li Z, Berger J, Moller DE. Inhibition of adipocyte differentiation by HIV protease inhibitors. J Clin Endocrinol Metab 1999; 84(11): 4274-7.
[http://dx.doi.org/10.1210/jcem.84.11.6234] [PMID: 10566684]
[47]
Mallon PW, Unemori P, Sedwell R, et al. In vivo, nucleoside reverse-transcriptase inhibitors alter expression of both mitochondrial and lipid metabolism genes in the absence of depletion of mitochondrial DNA. J Infect Dis 2005; 191(10): 1686-96.
[http://dx.doi.org/10.1086/429697] [PMID: 15838796]
[48]
Nolan D, Hammond E, Martin A, et al. Mitochondrial DNA depletion and morphologic changes in adipocytes associated with nucleoside reverse transcriptase inhibitor therapy. AIDS 2003; 17(9): 1329-38.
[http://dx.doi.org/10.1097/00002030-200306130-00007] [PMID: 12799554]
[49]
Hadigan C, Borgonha S, Rabe J, Young V, Grinspoon S. Increased rates of lipolysis among human immunodeficiency virus-infected men receiving highly active antiretroviral therapy. Metabolism 2002; 51(9): 1143-7.
[http://dx.doi.org/10.1053/meta.2002.34704] [PMID: 12200758]
[50]
Reeds DN, Mittendorfer B, Patterson BW, Powderly WG, Yarasheski KE, Klein S. Alterations in lipid kinetics in men with HIV-dyslipidemia. Am J Physiol Endocrinol Metab 2003; 285(3): E490-7.
[http://dx.doi.org/10.1152/ajpendo.00118.2003] [PMID: 12746213]
[51]
Mutimura E, Crowther NJ, Cade TW, Yarasheski KE, Stewart A. Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: A randomized controlled trial. AIDS Res Hum Retroviruses 2008; 24(1): 15-23.
[http://dx.doi.org/10.1089/aid.2007.0023] [PMID: 18275343]
[52]
Yarasheski KE, Tebas P, Stanerson B, et al. Resistance exercise training reduces hypertriglyceridemia in HIV-infected men treated with anti-viral therapy. J Appl Physiol 2001; 90(1): 133-8.
[http://dx.doi.org/10.1152/jappl.2001.90.1.133] [PMID: 11133903]
[53]
Cortés AJ. On how role versatility boosts an STI. J Theor Biol 2018; 440: 66-9.
[http://dx.doi.org/10.1016/j.jtbi.2017.12.018] [PMID: 29273545]
[54]
Günthard HF, Aberg JA, Eron JJ, et al. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312(4): 410-25.
[http://dx.doi.org/10.1001/jama.2014.8722] [PMID: 25038359]
[55]
McMahon JH, Elliott JH, Bertagnolio S, Kubiak R, Jordan MR, Jordan MR. Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: A systematic review. Bull World Health Organ 2013; 91(5): 377-385E.
[http://dx.doi.org/10.2471/BLT.12.112946] [PMID: 23678201]
[56]
Von Braun A, Sekaggya-Wiltshire C, Scherrer AU, et al. Early virological failure and HIV drug resistance in Ugandan adults co-infected with tuberculosis. AIDS Res Ther 2017; 14(1): 1.
[http://dx.doi.org/10.1186/s12981-016-0128-5] [PMID: 28086929]
[57]
Abdissa A, Yilma D, Fonager J, et al. Drug resistance in HIV patients with virological failure or slow virological response to antiretroviral therapy in Ethiopia. BMC Infect Dis 2014; 14(1): 181.
[http://dx.doi.org/10.1186/1471-2334-14-181] [PMID: 24708645]
[58]
Haile D, Takele A, Gashaw K, et al. Predictors of treatment failure among adult Antiretroviral Treatment (ART) clients in bale zone hospitals, south eastern Ethiopia. PLoS One 2016; 11(10): e0164299.
[http://dx.doi.org/10.1371/journal.pone.0164299] [PMID: 27716827]
[59]
Izudi J, Alioni S, Kerukadho E, Ndungutse D. Virological failure reduced with HIV-serostatus disclosure, extra baseline weight and rising CD4 cells among HIV-positive adults in Northwestern Uganda. BMC Infect Dis 2016; 16(1): 614.
[http://dx.doi.org/10.1186/s12879-016-1952-x] [PMID: 27793124]
[60]
Bienczak A, Denti P, Cook A, et al. Plasma efavirenz exposure, sex, and age predict virological response in HIV-infected African children. J Acquir Immune Defic Syndr (1999) 2016; 73(2): 161.
[61]
Bisaso KR, Karungi SA, Kiragga A, Mukonzo JK, Castelnuovo B. A comparative study of logistic regression based machine learning techniques for prediction of early virological suppression in antiretroviral initiating HIV patients. BMC Med Inform Decis Mak 2018; 18(1): 77.
[http://dx.doi.org/10.1186/s12911-018-0659-x] [PMID: 30180893]

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