Introduction: There is a high morbidity and mortality rate associated with chronic inflammation and fibrosis in HIV patients. Angiotensin II receptor blockers, such as losartan, are tested on HIV-infected individuals to determine whether they reduce inflammation and fibrosis.
Methods: One hundred HIV-positive patients on stable antiretroviral therapy were included in a randomized, double-blind, placebo-controlled trial. In a 12-month study, participants received losartan (50 mg/day) or a placebo. In order to evaluate the feasibility of this study, the primary endpoints included changes in inflammatory markers (C-reactive protein [CRP] and interleukin-6 [IL-6]) and fibrosis markers (transforming growth factor-beta [TGF-β] and liver stiffness measured by transient elastography). Blood samples and liver stiffness measurements were taken at baseline, 6 months, and 12 months. Statistical analysis included paired t-tests and repeated measures ANOVA to compare within-group and between-group differences.
Results: Of the 100 participants, 90 completed the study (losartan group, n=45; placebo group, n=45). The losartan group showed a significant reduction in CRP levels (mean decrease 1.2 ± 0.4 mg/L) compared to the placebo group (mean decrease 0.4 ± 0.2 mg/L, p < 0.01). IL-6 levels also decreased significantly in the losartan group (mean decrease 1.5 ± 0.5 pg/mL) versus the placebo group (mean decrease 0.6 ± 0.3 pg/mL, p < 0.01). TGF-β levels were significantly reduced in the losartan group (mean decrease 2.0 ± 0.6 ng/mL) compared to the placebo group (mean decrease 0.8 ± 0.4 ng/mL, p < 0.001). Liver stiffness showed higher reduction in the losartan group (mean reduction 2.5 ± 0.7 kPa) versus the placebo group (mean reduction 1.0 ± 0.5 kPa, p < 0.01).
Conclusion: As a result of losartan treatment, HIV patients experience a significant decrease in inflammation and fibrosis markers. As a result of these results, losartan could be used as an adjunctive therapy to treat chronic complications associated with HIV infection.