sVCAM‐1 and Hematological Profiles Are Associated With CD4‐Defined Disease Status in HIV Infection

ABSTRACT

Brazil stands out for its progressive public health policies against HIV, including universal access to antiretroviral therapy and a stricter AIDS definition (CD4 < 350 cells/mm ³ ) compared to the World Health Organization (WHO) criterion (CD4 ≤ 200 cells/mm ³ ). Although CD4 + T‐cell count is the primary marker of immunosuppression, it may not fully reflect the complexity of immune dysfunction during HIV infection. Soluble adhesion molecules, including sVCAM‐1, sICAM‐1, sL‐selectin, sE‐selectin, and sP‐selectin, have emerged as potential biomarkers due to their roles in leukocyte trafficking and endothelial activation. This study primarily consisted of a cross‐sectional analysis, including 127 antiretroviral‐naive people living with HIV (PLHIV) and 40 HIV‐negative controls, complemented by a small longitudinal follow‐up of 33 PLHIV after antiretroviral therapy initiation. PLHIV were categorized into AIDS (CD4 < 350 cells/mm ³ ) and NO‐AIDS (CD4 ≥ 350 cells/mm ³ ) groups. Molecule concentrations were quantified using Cytometric Bead Array (CBA). Group comparisons and correlations were assessed using Kruskal–Wallis followed by Dunn's multiple comparisons test, Wilcoxon signed‐rank test, and Spearman correlation analysis. Multivariate analyses, including Principal Component Analysis (PCA) and unsupervised K‐means clustering, were performed using R software to explore global patterns in laboratory and adhesion molecule data. sVCAM‐1 levels were significantly lower in the AIDS group compared to both NO‐AIDS individuals and controls ( p  < 0.0001 for both comparisons). ROC curve analysis showed that sVCAM‐1 discriminated AIDS from NO‐AIDS individuals with an AUC of 0.79 (95% CI: 0.7060–0.8769), 67.9% sensitivity, and 86.4% specificity. Although sE‐selectin showed an overall trend toward differences across groups, these differences did not remain statistically significant after correction for multiple comparisons. PCA revealed substantial overlap between groups, with hematological and leukocyte‐related parameters contributing more strongly to multivariate variability than adhesion molecules. Together, these findings suggest that sVCAM‐1 is associated with CD4‐defined disease status and may represent a complementary research biomarker requiring further validation in HIV infection.