Inflammation, Immune Activation, and Antiretroviral Therapy in HIV
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Purpose of Review
This review focuses on the differential effects of contemporary antiretrovirals on systemic inflammation as heightened immune activation is linked to important co-morbidities and mortality with HIV infection.
Antiretroviral therapy (ART) reduces dramatically systemic inflammation and immune activation, but not to levels synchronous with HIV-uninfected populations. In one ART initiation trial, integrase inhibitors appear to reduce inflammation to a greater degree than non-nucleoside reverse transcriptase inhibitors (NNRTIs); however, it is not clear that there are beneficial effects on inflammation resulting from treatment with integrase inhibitors compared to PIs, between PIs and NNRTIs, between specific nucleoside reverse transcriptase inhibitors, or with maraviroc in ART-naïve patients. In ART switch studies, changing to an integrase inhibitor from a PI-, NNRTI-, or enfuvirtide-containing regimen has resulted in improvement in several markers of inflammation.
Additional research is needed to conclusively state whether there are clear differences in effects of specific antiretrovirals on inflammation and immune activation in HIV.
KeywordsAntiretroviral therapy Inflammation Immune activation HIV infection
This manuscript was supported by the National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interest
Corrilynn O. Hileman has received grant support from the National Institutes of Health (K23HL116209) and has served as consultant to Gilead Sciences.
Nicholas T. Funderburg has received grant support from the National Institutes of Health (R01HL134544).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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