Fecal Calprotectin Is Elevated in HIV and Related to Systemic Inflammation

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 86; no. 2; pp. 231 - 239
• Main Authors: Eckard, Allison Ross, Hughes, Heather Y., Hagood, Nancy L., O'Riordan, Mary Ann, Labbato, Danielle, Kosco, Julia C., Scott, Sarah E., McComsey, Grace A.
• Format: Journal Article
• Language: English
• Published: United States JAIDS Journal of Acquired Immune Deficiency Syndromes 01-02-2021; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Biomarkers - blood; C-Reactive Protein - metabolism; CD4 Lymphocyte Count; Enzyme-Linked Immunosorbent Assay; Feces - chemistry; Female; HIV Infections - drug therapy; Humans; Inflammation - complications; Leukocyte L1 Antigen Complex - therapeutic use; Male; Middle Aged; Young Adult
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0000000000002538

BACKGROUND:Fecal calprotectin (FC), a biomarker of gastrointestinal inflammation, is used in the diagnosis and management of inflammatory bowel disease (IBD). HIV infection severely damages gut-associated lymphoid and epithelial tissues leading to gastrointestinal inflammation which drives systemic inflammation and increases subsequent risk of co-morbidities. For the first time, we compared FC concentrations by HIV and antiretroviral therapy (ART) status and determined the relationship to systemic inflammation.
METHODS:People with and without HIV were enrolled and underwent a comprehensive clinical and laboratory assessment. Stool samples were collected, and FC was measured by ELISA. Plasma biomarkers of inflammation were also measured.
RESULTS:101 participants with HIV (83 ART-treated; 18 ART-naïve) and 89 uninfected controls were enrolled. There were no significant differences between ART-naïve and ART-treated participants, but both HIV groups had significantly higher FC concentrations compared to controls when FC was considered as a continuous variable or by cut-offs used in IBD. The highest median and largest proportion of participants with FC >100 µg/g were seen in ART-naïve followed by ART-treated and then controls. Among HIV participants, FC concentrations were positively associated with high-sensitivity C-reactive protein, soluble tumor necrosis factor-II, and soluble vascular cellular adhesion molecule and inversely associated with CD4 counts.
CONCLUSION:FC concentrations are elevated in HIV regardless of ART status. ART and immune reconstitution appear to reduce FC but not to concentrations seen in uninfected controls. Our results suggest a role for FC as a non-invasive surrogate measurement of GI inflammation and associated systemic inflammation in HIV.