| dc.description.abstract | Despite significant decline in HIV-1 infection rates from up-scaling of Anti-Retroviral
Therapy (ART) accessibility, Kenya is among leading African countries in prevalence.
Siaya has second highest prevalence among Kenyan counties. Interferon-gamma (IFN-γ)
and interleukin 10 (IL-10) are among the vital cytokines expressed during immune
responses to infections, majorly by CD4+ T- cells. HIV infection of CD4+ T cells
dysregulates the expression of these key cytokines. Antiretroviral treatment (ART) is
meant to lower the viral load and serves to restore a balance in the immune system
including normal CD4+ T-cell counts, and IFN-γ and IL-10 levels. Non-adherence to ART
impairs viral suppression, thereby undermining restoration or maintenance of immune
balance. However, it is not clear how non-adherence to ART affects the circulating levels of
cytokines especially IFN-γ and IL-10. This study determined the effect of non-adherence to
ART on circulating levels of IFN-γ and IL-10, and clinical outcomes of therapy. This cross
sectional study was conducted on 163 individuals comprising of the HIV-1 ART-naive
individual, HIV-1, HIV-1+ ART-adherent and HIV-1+ ART-non-adherent attending Siaya
County Referral Hospital. HIV-1 status was determined by automated Abbott m2000
System, Viral load was measured using the COBAS® AmpliPrep/COBAS® TaqMan®,
while CD4 count and cytokines measurement were done using BD PRESTO and
Sandwiched ELISA respectively. The serum IFN-ɤ and IL-10 levels for HIV-1 -ve, HIV-1
[+] ART-naive, HIV-1 [+] ART-adherent, HIV-1 [+] ART-Non-adherent were: (5.73 vs.
5.89; 0.74 vs. 32.26; 2.55 vs. 14.9 and 0.98 vs. 26.73) pg/MmL. The CD4 T cell count was
significantly lower in the HIV [+] ART-Naïve group (median, 395.9 IQR 349 copies per
microliter of blood) as compared to HIV-1 negative (median 1407.4 IQR 1303 copies per
microliter of blood), HIV [+] ART-Adherents, median, 575.4 IQR 374 copies per
microliter of blood) and HIV [+] ART-Non-Adherents, median, 423.6, IQR, 252 copies per
microliter of blood); P <0.001. Conversely, the viral load was higher in HIV [+] ART-Non
Adherents, median, 4.6, IQR 1.1 copies per microliter of blood), than HIV [+] ART
Adherents, median, 3.4, IQR 1.9 copies per microliter of blood) and HIV [+] ART-Naïve,
median, 4.5, IQR, 1.6 copies per microliter of blood); P <0.001. Interleukin 10 (IL-10)
levels correlated positively with viral load (ρ= 0.272; P=0.004) and inversely with CD4 T
cell count (ρ= -0.627; P<0.0001) as well as BMI (ρ= -0.376; P<0.0001). Nevertheless,
there was a negative correlation observed between IFN-γ and both viral load (ρ= -0.326;
P<0.0001) and BMI (ρ= -0.342; P<0.0001). Conversely, a positive correlation was found
between IFN-γ and CD4 T cell count (ρ= 0.619; P<0.0001). The present investigation has
revealed that the lack of adherence to highly active antiretroviral therapy (HAART) among
patients infected with HIV-1 has a significant impact on the levels of pro-inflammatory and
anti-inflammatory cytokines in the blood. This disruption in cytokine balance has the
potential to disturb the delicate equilibrium between these two opposing factors. It is
proposed that the measurement of serum levels of IFN-γ and IL-10 may serve as viable
indicators for the purpose of monitoring the development of HIV-1 infection. | en_US |
