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Aspirin does not affect immune activation, endothelial function of HIV patients

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BOSTON — HIV patients given a regimen of aspirin with ART did not demonstrate any changes in immune activation or endothelial function, according to late-breaking data presented at CROI 2016.

“We’re learning that soluble markers of inflammation, immune activation and coagulation predict non-AIDS-defining morbid events during suppressive ART, and we’re starting to see that platelets are another cell type that might be activated during chronic HIV infection,” Meagan P. O’Brien, MD, assistant professor of infectious diseases at the Icahn School of Medicine at Mount Sinai, said during a presentation. “So we asked the question, ‘Might antiplatelet agents decrease immune activation in antiretroviral-treated HIV infection?’ ”

O’Brien and colleagues enrolled 121 HIV patients with a history of at least 48 weeks on ART into the randomized, double blind trial. These participants were given either 300 mg of aspirin (n = 40), 100 mg of aspirin (n = 41) or placebo (n = 40) for 12 weeks. Following a 4 week washout period, the researchers examined patients for any change in sCD14, along with secondary outcomes of flow-mediated dilation, serum thromboxane, D-dimer and safety.

Aside from eight participants who did not finish treatment due to nonadherence or complicating infection, all participants demonstrated viral loads of fewer than 50 copies/mL. Eligible participants were 81% male (median age, 49 years) and had a median CD4 T-cell count of 616/mm³.

Aspirin was well-tolerated by the patients, with the only protocol-defined toxicity occurring in the placebo arm. Significant thromboxane inhibition was observed in the patients, suggesting high adherence and successful inhibition of cyclooxygenase, the researchers wrote. Aside from an increase in sCD163 observed in the 300 mg arm, aspirin was largely ineffective with neither arm reporting any difference in sCD14 or the other immunologic endpoints when compared with placebo. When analyzing for interactions by current smoking, sex, age, ART regimen and baseline marker tertile, sCD163 increases due to aspirin were diminished among smokers and women, while D-dimer decreased further among smokers.

“Aspirin for 12 weeks does not appear to have a major impact on immune activation or endothelial function in ART-suppressed HIV-infected individuals,” O’Brien said. “While this study does not support the use of aspirin as an anti-inflammatory in patients with HIV infection, there may be some subgroups that derive benefit, which could be explored in future studies.” – by Dave Muoio

Reference:

O’Brien MP, et al. Abstract 44LB. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.