Background: E-selectin is an adhesion molecule that is expressed on the surface of
activated endothelial cells. During inflammation the endothelial cells are activated,
trafficking cells of the immune system through the endothelial wall to the point of
inflammation. Human Immunodeficiency Virus (HIV) infection causes continuous
and long term activation of the immune system and has an increased incidence of
cardiovascular disease. Selectins play an important role in atherosclerotic plaque
formation as continuous activation leads to plaque formation and eventual plaque
rupture with subsequent thrombosis and the initiation of a cardiac event. The aim of
this study was to determine the levels of E-selectin in an HIV infected and control
population and to correlate these levels with markers of HIV disease severity,
inflammation and coagulation in anti-retroviral treatment (ART)-naïve HIV infected
individuals.
Methods: E-selectin levels were determined using ELISA in 180 participants from an
HIV prevention and testing clinic in Crossroads, Cape Town. There were 114 HIV
infected cases and 66 HIV negative controls. These levels were compared with each
other and correlated to various other markers associated with HIV disease severity
(viral load and CD4+count), inflammation (white cell count (WCC), high sensitivity
C-reactive protein (hsCRP), %CD38/8, albumin and IgG) and coagulation
(fibrinogen and D-dimer).
Results: A total of 75% of the females tested positive for HIV compared to 37% of
the males. Statistics comparing HIV status with WCC, CD4+count, %CD38/8,
albumin, IgG, hsCRP and D-dimer found significant differences (p<0.01) between
the two groups. No differences in E-selectin (p=0.84) and fibrinogen (p=0.65) levels
were found between the cases and the controls. When E-selectin was compared with
all the analytes tested, significant correlations were found with age (p=0.02) and
gender (p=0.01). Albumin (p=0.05) showed a significant correlation with E-selectin
in the control group. The correlation with the WCC (p=0.07) in the HIV infected
group neared significance. Conclusion: No significant difference in E-selectin levels was found between the
HIV positive and negative control group and no correlations were found with Eselectin
and the markers of disease severity, inflammation and coagulation. Thus we
found E-selectin to be a poor marker of inflammation in this setting. As age and
gender are established markers of CVD and males have higher E-selectin levels than
females, the lack of significance may be due to our sample population’s young age
(mean 31 years) or the fact that 70% of the cohort was female. Thus significant
endothelial damage may not yet have taken place to increase E-selectin levels. In
addition, this HIV group was predominantly in the chronic stage of infection,
therefore the increase in E-selectin levels may have occurred earlier during the acute
infectio
