As posited by Sara E. Looby and collaborators, factors associated with immune activation indices which contribute to cardiovascular disease (CVD) in individuals with human immunodeficiency virus (HIV) have not been defined. Using the global REPRIEVE trial’s cohort, the researchers evaluated soluble CD14 (sCD14) and oxidized LDL (oxLDL) and found differing factors associated with these “two key indices of immune-mediated CVD risk.” Their report was published in Clinical Infectious Diseases.

The full cohort analyzed in this study included 4,907 patients from five Global-Burden-of-Disease regions (38% female; 48% Black; median age 50 years). Levels of sCD14 and oxLDL were assessed for any associations with patients’ demographic characteristics. According to the authors, “when levels of sCD14 and oxLDL were characterized by sex, age, and region, female sex and residence in South Asia or Sub-Saharan Africa were associated with higher sCD14 levels while residence in high-income regions was associated with higher oxLDL levels.”

In their adjusted analysis, the authors found that female sex and white race (among those in high-income regions) were associated with higher sCD14 levels, while higher BMI and use of NRTI+INSTI-based antiretroviral therapy were associated with lower sCD14 levels. In adjusted oxLDL models, male sex, residence in high-income area, and higher BMI were associated with higher levels. Lastly, a sub-analysis of women with HIV (n = 1,396) found that “increased reproductive age was associated with higher sCD14 levels but not with higher oxLDL levels.”

While the authors did not identify definitive factors of immune activation for the purpose of CVD prevention in people with HIV, they presented their data to support future research, which they suggested should “elucidate ways in which medications (e.g. statins) and behavioral modifications influence sCD14/oxLDL and the extent to which dampening of these markers mediates CVD-protective effects.”