Immunometabolism in cardiovascular disease and diabetes mellitus during treated HIV infection
Immunometabolism in cardiovascular disease and diabetes mellitus during treated HIV infection Tiffany Roxanne Butterfield Cardiovascular disease (CVD) and diabetes mellitus (DM) have become prevalent co-morbidities for persons living with HIV (PLWH) in high income countries. Both diseases are associated with chronic inflammation and immune activation in treated PLWH, with monocytes and T cells suggested to be important contributors of inflammation. Elevated glucose metabolism in monocytes and T cells is linked to inflammatory functions, but the role of heightened glucose metabolism in immune cells in PLWH with CVD or DM is unknown. HIV+ participants from the Women’s Interagency HIV Study (WIHS) cohort were selected by the presence of subclinical CVD or DM and matched to controls. HIV+ women with DM showed evidence of increased glucose metabolism in CD4+ T cells compared to HIV+ women without DM and HIV‒ women with DM. In HIV+ women with subclinical CVD there was evidence of increased glucose metabolism in intermediate monocytes compared to HIV+ women without subclinical CVD. These results suggest that immunometabolism in PLWH may be a contributing factor towards DM and CVD. Whether these results are also applicable in a low- and middle-income country (LMIC) setting is uncertain. Accordingly, the prevalence of CVD risk in HIV+ participants enrolled at the CHARES clinic of the UHWI in Jamaica was assessed by measuring HDL cholesterol concentration. Most participants had intermediate high risk of CVD at enrolment and intermediate risk of CVD at 3-years post enrolment. HIV+ males were more likely to be classified as high risk and this was associated with high viral load and low CD4 count at 3-years post enrolment. In summary, immunometabolism was associated with CVD and DM in PLWH in a high income setting and the identification of CVD being prevalent in HIV+ Jamaicans warrants additional investigation to determine if immunometabolism is also relevant to CVD in a LMIC context. Keywords: HIV, immunometabolism, cardiovascular disease, diabetes mellitus, monocytes, CD4+ T cells.