HIV Treatment Associated with Reduced Scar Tissue in Fat, Lymph Nodes of People Living with HIV

Boston, MA – Treatment for HIV infection is associated with a reduction in the amount of scar tissue in the lymph nodes and fat of people living with HIV, according to the results of a study published today in the Journal of Infectious Diseases.

The study was conducted by the AIDS Clinical Trials Group (ACTG) Network and funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

“This study demonstrates that long-term antiretroviral therapy has a newly recognized benefit that may help improve the overall health of people living with HIV,” said Judith Currier, M.D., ACTG Network Chair and Principal Investigator. “In addition, the study highlights the importance of looking at the impact of interventions at the tissue level, beyond what we can measure in blood.”

Scar tissue, or fibrosis, tends to develop in the fat and lymph nodes of people living with HIV for reasons that are not understood. Fibrosis in the lymph nodes limits how well antiretroviral therapy (ART) can restore key immune cells that the virus depletes and may enable HIV to persist in the lymph nodes. Fat fibrosis can increase the harmful phenomenon called inflammation in people living with HIV and contribute to end-organ disease.

To try to reduce fibrotic and inflammatory contributors to end-organ disease in people living with HIV, ACTG scientists hypothesized that a blood pressure medication called telmisartan would decrease scar tissue in the lymph nodes and fat of people who were taking virally suppressive ART. Previous studies in animal models had indicated that telmisartan could reverse fibrosis in the kidney and liver and could treat metabolic syndrome, but the drug had not yet been used to treat fibrosis in people living with HIV.

The clinical trial, called ACTG A5317, enrolled 54 participants on ART at 11 U.S. sites beginning in 2014. Participants were assigned at random to take either daily telmisartan or no drug for 48 weeks, in addition to their daily antiretroviral drug regimen. The participants consented to having tissue biopsies of both fat and lymph nodes when they entered and completed the study. The study team monitored participants’ safety throughout the trial.

Investigators found that although telmisartan had no effect on fibrosis or inflammation, however, continuing virally suppressive ART throughout the study period was associated with a reduction in the amount of scar tissue in the lymph nodes and fat. The amount of scar tissue in the lymph nodes decreased by a median of 2.6% (with a median at entry of 13.7%) and in the adipose tissue by 1.3% (with a median at entry of 1.9%).

“These findings give us hope that fibrosis is reversible and perhaps other drugs will be effective at reducing it even more than suppressive anti-HIV treatment can,” said Netanya Utay, M.D. Dr. Utay was a co-chair investigator of A5317 and is an assistant professor at the University of Texas Health Science Center at Houston.

“This is the first study to show that people living with HIV who don’t have lipodystrophy or obesity still have fat fibrosis, which could help explain some of the metabolic problems we see in this population,” added Jordan Lake, M.D., M.Sc. Dr. Lake was a co-chair investigator of A5317 and is an associate professor at the University of Texas Health Science Center at Houston.

Please click here to down the press release

About the ACTG Network

The ACTG Network is the largest HIV/AIDS clinical trials group in the world, with 34 domestic and 25 international sites. The mission of the ACTG Network is to cure HIV infection and reduce the burden of disease due to HIV infection and its complications, including tuberculosis and viral hepatitis. NIAID funds the ACTG Network.

www.ACTGNetwork.org