Health Disparities and Novel Biomarkers for HIV-1 Disease Progression

Purpose: According to the World Health Organization, thirty five million people are living with a diagnosed HIV infection worldwide and approximately a million in the United States. The burden of illness in the United States falls disproportionately on ethnic/racial minorities. After the advent of antiretroviral therapy (ART) and greater life expectancy of infected individuals there is a significant increase in cognitive impairment or HIV-1 associated neurocognitive disorders (HAND-30-60%). Research indicates that pro-inflammatory proteins and other biomarkers may correlate with the level of neurological impairment. We propose biomarkers including sCD40L, correlate with the level of neurological impairment and these factors may vary in individuals living with HIV/AIDS dependent on their age, gender, racial/ethnic background and disease progression. Methods: HIV-1 seropositive Caucasian, African American and Hispanic men and women (20 in each category) older than 20 years were recruited from clinics in Dallas- Fort Worth metroplex area. The study visit included informed consent, drug screening, HIV-1 relevant medical history review, socio-demographic survey, neurocognitive assessment (CNS vital signs) and blood sampling. Patients will be followed up for a second visit a year later. Patient samples (Plasma, Cellular DNA, RNA and protein) were isolated for biomarker analysis. Database was compiled in socio-demographic, virological, medical history, neurocognitive, and inflammatory biomarkers parameters. Database was coded in categorical and numerical variables .The difference in protein levels between gender, cognitive status and race/ethnicity was analyzed by SPSS. Episomal 2-LTR circles were also tested and are important markers for ongoing viral replication and viral latency. Results: Preliminary screening of whole plasma samples from participants showed observable levels for sCD40L and other inflammatory biomarkers, which correlated with the socio-demographic and neurocognitive test data for all first visit subjects. Episomal 2-LTR circles were quantified. Conclusion: Pro-inflammatory biomarker levels can be accurately measured in patient plasma samples to correlate between different gender, racial/ethnic background and disease progression. HIV-1 cDNA levels can be a useful tool in monitoring therapy in HIV-1 infected individuals. We expect to obtain and verify trends in immune biomarkers in context of race/ethnic backgrounds.