Article Dans Une Revue Infectious Diseases Now Année : 2025

Clinical, biological, metabolic and immune changes associated with the use of Sodium-glucose cotransporter 2 inhibitors in people living with HIV

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Introduction : Positive cardiovascular and renal outcomes associated with the Sodium-Glucose cotransporter 2 inhibitor (SGLT2i) use are attributed to their anti-inflammatory properties. Persistent immune activation accounts for part of people living with HIV (PWH) elevated cardiovascular risk, but SGLT2i impact on this population has been poorly described. Methods: All PWH with a history of SGLT2i treatment from May 2020 to April 2023 receiving care at Pitié-Salpêtrière Hospital (Paris, France) with pre-and post-treatment available blood samples were included. Clinical and biological data were extracted from medical records, metabolic and immune biomarkers from cryopreserved plasma samples.

Results: Most of the 20 patients with SGLT2i treatment were male (75%), with a median

[IQR] age of 59 [55;68] years, receiving antiretroviral therapy for a median of 21.5 [15.3;26.5] years. Most had type 2 diabetes (95%), chronic kidney disease (90%), dyslipidemia (80%), and hypertension (75%). SGLT2i treatment was associated with a median of 3 kg weight loss, an increase in hematocrit and decreased AST levels. LDL, HDL, oxLDL and Lp-PLA2 levels were unaffected. SGLT2i was associated with inflammasome inhibition, with decreased circulating levels of IL-1β and IL-8. There was also a decrease in cytokines associated with the recruitment and activation of monocytes-macrophages MCP-1, MIP-1α, MIP-1β, Eotaxin, RANTES, IL-8, and their positive feedback, IL-13/IL-4. Decreased IL-6, CRP and sCD14 levels were non-significant. Conclusion : on PWH, SGLT2i was associated with weight loss and a broad impact on innate immunity, with inhibition of inflammasome and monocyte-macrophage activation.

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hal-04954331 , version 1 (18-02-2025)

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Vincent Guiraud, Delphine Sauce, Randa Bittar, José Fernandez, Henri Thévenet, et al.. Clinical, biological, metabolic and immune changes associated with the use of Sodium-glucose cotransporter 2 inhibitors in people living with HIV. Infectious Diseases Now, 2025, pp.105040. ⟨10.1016/j.idnow.2025.105040⟩. ⟨hal-04954331⟩
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