Sex differences in cytokine profiles during suppressive antiretroviral therapy

Objective: Despite lower plasma HIV RNA levels, women progress faster to AIDS than men. The reasons for these differences are not clear but might be a consequence of an elevated inflammatory response in women. Methods: We investigated sex differences in cytokine profiles by measuring the concentrations of 36 cytokines/chemokines by Luminex in blood of women and men (sex at birth) with chronic HIV infection under suppressive therapy. We initially performed a principal component analysis to see if participants clustered by sex, and then fit a partial least squares discriminant analysis (PLS-DA) model where we used cytokines to predict sex at birth. The significance of the difference in nine cytokines with VIP greater than 1 was tested using Wilcoxon test-rank. Further, potential confounding factors were tested by multivariate linear regression models. Results: Overall, we predicted sex at birth in the PLS-DA model with an error rate of approximately 13%. We identified five cytokines, which were significantly higher in women compared with men, namely the pro-inflammatory chemokines CXCL1 (Gro-alpha), CCL5 (RANTES), CCL3 (MIP-1 alpha), CCL4 (MIP-1 beta), as well as the T-cell homeostatic factor IL-7. The effect of sex remained significant after adjusting for CD4(+), age, ethnicity, and race for all cytokines, except for CCL3 and race. Conclusion: The observed sex-based differences in cytokines might contribute to higher immune activation in women compared with men despite suppressive therapy. Increased levels of IL-7 in women suggest that homeostatic proliferation may have a differential contribution to HIV reservoir maintenance in female and male individuals. Our study emphasizes the importance of sex-specific studies of viral pathogenesis.

Automated summary

Despite lower plasma HIV RNA levels, women progress faster to AIDS than men, which might be a consequence of an elevated inflammatory response in women. Our study found that women had higher levels of certain cytokines compared to men, suggesting higher immune activation in women under suppressive therapy.