Accessible Requires Authentication Published by De Gruyter October 20, 2015

Evaluating the use of procalcitonin in an asymptomatic, HIV-infected antiretroviral therapy-naïve, South African cohort

Dineo V. Phatlhane, Hayley Ipp, Rajiv T. Erasmus and Annalise E. Zemlin


Background: The chronic stage of human immunodeficiency virus (HIV) infection, although clinically asymptomatic, is characterized by activation of the immune system and persistent inflammation. Procalcitonin (PCT) has been studied in HIV infection as a marker of bacterial infection. Our aim was to assess the effect of persistent immune activation on PCT levels in asymptomatic treatment naïve HIV infected subjects.

Methods: This was a cross-sectional study of 68 asymptomatic antiretroviral therapy-naive HIV infected participants and 42 uninfected controls. Stored serum samples were used to measure: PCT, interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP), high sensitivity C-reactive protein (hsCRP), immunoglobulin G (IgG) and albumin. PCT was correlated with markers of: disease progression (CD4 count and viral load), immune activation (CD 38 on CD8+ T cells, IgG and LBP), inflammation (IL-6, hsCRP and albumin).

Results: IL-6, IgG and CD8/38 were all significantly increased while albumin and CD4 counts were significantly lower in the HIV infected group. PCT levels were not significantly different between the two groups. There was no significant difference in LBP and hsCRP; however, their levels were increased in both groups. PCT correlated only with LBP (p=0.0001). IL-6 and LBP correlated positively with hsCRP and IgG. Albumin correlated inversely with IL-6 and viral load. Only IgG and CD8/38 correlated inversely with CD4 counts.

Conclusions: We demonstrated the activation of the innate (raised LBP), humoral (raised IgG) and cellular immune systems (increased CD8/38 T cells). Despite a state of persistent inflammation, PCT levels are not elevated in asymptomatic untreated HIV infection.

Corresponding author: Annalise E. Zemlin, MBChB, FCPath (SA) (Chem), MMed (Chem Path), National Health Laboratory Service (NHLS), Department of Chemical Pathology, University of Stellenbosch, Tygerberg Hospital, Cape Town, P.O. Box 19113, Tygerberg, 7505, South Africa, Phone: +27(21)9384254, Fax: +27(21)9384640, E-mail:


We wish to thank the patients and staff of the Emavundleni Prevention Center of the Desmond Tutu HIV Center Crossroads Cape Town for their participation. In addition, we would like to thank Michael McCaul of the Biostatistics Unit at Stellenbosch University for his help with the statistical analysis.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This research was supported by the following funding bodies: National Health Laboratory Services (NHLS) (Grant/Award Number: 94435). Research Trust, NHLS K-funding, and Harry Crossley Foundation.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Ethical approval: The study was approved by University of Stellenbosch Ethics Committee (HREC S14/04/078) and performed according to the Declaration of Helsinki. All participants signed informed consent explained to them in their language of choice.


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Received: 2015-6-12
Accepted: 2015-8-4
Published Online: 2015-10-20
Published in Print: 2016-3-1

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