Abstract:
Introduction: persistent low-level viremia (pLLV) in
HIV-1 participants on combination antiretroviral
therapy (cART) is a significant predictor of immune
activation and virologic rebound. Elevated cytokine
levels are linked to pLLV, yet the roles of pro- and
anti-inflammatory cytokines remain unclear in
settings such as Kenya. This study assessed IL-17,
IFN-γ, IL-10, and TGF-β in HIV-1 pLLV and virally
suppressed participants at Moi Teaching and
Referral Hospital (MTRH) to explore alternative
biomarkers for virologic monitoring in resource-
limited settings. Methods: cross-sectional study of
82 age- and gender-matched HIV-1 participants on
first-line cART, -41 pLLV (50-500 copies/ml), and 41
virally suppressed (<50 copies/ml) was conducted
using MTRH database data. Plasma cytokines (IL-
17, IFN-γ, IL-10, TGF-β) were measured by ELISA
(Zeptometrix, USA), and viral loads by RT-PCR
(Abbott, USA). Data were analyzed using Mann-
Whitney U, Chi-squared, and logistic regression
tests. Results: the median (IQR) levels of IL-17, IFN-
γ, IL-10, and TGF-β (pg/ml) were significantly
higher in pLLV participants on first-line cART
compared to virally suppressed participants: 23.8
(21.3-25.8) vs. 15.5 (12.7-18.2); 28.3 (23.5-31.2) vs.
11.4 (8.8-14.8); 45.2 (34.0-53.7) vs. 28.4 (22.6-
31.6); and 56.9 (50.0-67.8) vs. 27.7 (19.5-34.7)
p<.001. The odds (95% CI) of being suppressed
were reduced by TGF-β 0.329 (0.035-0.361), IFN-γ,
0.360 (0.270-1.501, and IL-17 0.938 (0.691-1.273),
but increased by IL-10 1.106 (0.675-1.811), though
not statistically significant. Conclusion: persistent
low-level viremia (pLLV) presents with elevated
pro-inflammatory (IL-17, IFN-γ) and anti-
inflammatory cytokines (IL-10, TGF-β) levels.
Recommendation: exploring other cytokines in
pLLV could enhance understanding of cytokine
levels and viral suppression and may help refine
HIV-1 treatment
