Association Of Nadir Cd4 Counts With Carotid-Intima Media Thickness And Inflammation Markers In Hiv Infected Patients

Background: During HIV infection, apart from use of PI-based regimen, low CD4+ T-cell count has also been identified as a vascular risk factor. Initiating ART in patients with higher nadir CD4 counts is speculated to better normalise CVD risks and inflammatory response. We aimed to study effect of nadir CD4 count on CVD and inflammatory response in ART naive and treated HIV patients. Methods & Materials: Cross-sectional enrolment of 169 HIV-infected patients (68 naive; 101 ART experienced) with different nadir CD4 counts; Drug Naive(DN)- Group 1 (n=24;Nadir CD4<350cells/μL); Group2 (n=44;Nadir CD4>350cells/μL); ART experienced- Group 3 (n=32;Nadir CD4 <200cells/μL);Group 4 (n=36;Nadir CD4 200-350cells/μL);Group 5 (n=33;Nadir CD4 >350cells/μL) and Group 6 (n=29 healthy controls (HC) were done. We measured serum lipid profile (LP), C-IMT, cardiac output, TNFR-1, TNFR-2 for inflammation, sCD14 for microbial translocation (MT) by ELISA. Descriptive statistics were used for demographics; ANOVA to identify differences in LP, C-IMT, cardiac output, inflammation, MT between groups. Results: Mean age, median current and nadir CD4 count for groups 1-5: 37.7±5.6, 123.5(70-273.5), 123.5(70-273.5); 35.36±5.2, 534(440-595), 572(496.5-761.25); 38.7±5.7, 138.5(83-167.5), 569(430.25-773.5); 38.3±5.9, 273.5(228.5-317.5), 717(564-867.5); 40.3±5.1, 402(378-438), 777(649-1005); 37±5.9. C-IMT (p<0.05), TC, TG, TNFR-2, sCD14 (p<0.05) increased in DN and ART than HC. Cardiac output (p<0.001) decreased, TNFR-1 (p=NS), TNFR-2 (p<0.001), sCD14 (p<0.001) higher in DN than ART. No significant difference in C-IMT between groups based on nadir CD4 counts. In naive patients, increased cardiac output (p<0.001), decreased TNFR-1 (p<0.001), TNFR-2 (p<0.001) and sCD14 (p<0.001) was seen in group 2 than group 1. We did not identify statistically significant difference in LP, cardiac output, TNFR-1, TNFR-2, sCD14 levels between groups 3-5. We identified significant correlation (p<0.05) between low CD4 count and increase in C-IMT on ART patients. Conclusion: From clinical perspective, no significant betterment in terms of decrease in inflammatory response, C-IMT and increase in cardiac output was identified during early initiation of ART. However, we found significant increase in inflammatory and MT markers in naive patients with nadir CD4 <350 cells/μL than those with higher nadir CD4 count.