The role of inflammatory biomarkers in understanding disease pathogenesis and improving clinical care in people with HIV

The monumental success of antiretroviral therapy (ART) has now led to a shift of morbidity and mortality in people with HIV (PWH) away from AIDS-related conditions towards non-infectious or non-communicable complications that include cardiovascular disease, liver and renal disease, osteoporosis/osteopenia, and other diseases of aging that are strongly linked to inflammation. This is important as now >50% of PWH are over the age of 50 and CD4 with viral load cannot predict higher rick of non-infectious complications, which highlights to the need for novel biomarkers for risk assessment in PWH on ART.
In my thesis, I outline how evaluation of inflammatory biomarkers in PWH at different stages of disease (untreated advanced or early versus chronic with suppressed plasma viremia) may help assess risk of comorbidities and prognosis; how gut microbiome may relate to inflammation and non-infectious complications in the aging HIV population and how biomarkers could be utilized in pilot clinical trials to assess efficacy of anti-inflammatory interventions.
In summary, we are at the cusp of a big change in clinical care of PWH where the focus has transitioned to addressing aging and comorbidities. As such, future efforts to integrate inflammatory biomarkers in risk assessment and prognosis will be critical for better personalized medicine and healthy aging in this population. Finally, evaluation of biomarkers is essential for better understanding the pathogenesis of inflammation in HIV and may open venues for novel targeted interventions.