Abstract

Highly active antiretroviral therapy (HAART) effectively controls HIV replication in HIV-positive individuals, but chronic immune activation persists, leading to increased virus replication, T cell depletion, and exhaustion, necessitating lifelong HAART to prevent disease progression. This study explores the potential of supplementing HAART with Artemisia annua and Moringa oleifera leaf powders as adjuvants to restore immune function and control viral replication in people living with HIV/AIDS (PLWH). A nested cohort study was conducted with 31 PLWH on HAART randomized to the control group (n = 15) and the intervention group (n = 16) that supplemented HAART with A. annua and M. oleifera leaf powder. Peripheral blood mononuclear cells (PBMCs) were obtained from the study participants to measure the expression of activation markers (IFN-γ, IL-2, IL-10, and HLA-DR), inhibitory and degranulation receptors (PD-1 and CD107a, respectively) expressed by CD4+ and CD8+ T cells using flow cytometry at baseline and 12 months. Viral load was also measured using quantitative polymerase chain reaction (qPCR). Compared to the controls on HAART only, patients in the intervention group had increased frequencies of CD4+ T cells (p = 0.003), decreased viral load (p = 0.046), and decreased production of IL-10 (p = 0.010). A non-significant trend showing a decrease in the degranulation marker (CD107a), exhaustion marker (PD-1), and activation markers (HLA-DR, IL-2, and IFN-γ) produced by CD4+ and CD8+ T cells were also observed. The study revealed that HAART supplementation with M. oleifera and A. annua causes faster viral load suppression and elevation of CD4+ T cells with suppressed IL-10 expression. Co-supplementation also increases the expression of CD4+ T cells associated with the suppression of PD-1 and elevation of IL-2 expression, suggesting virological and immunological recovery among patients on HAART.

Key words: Artemisia annua, Moringa oleifera, people living with HIV/AIDS (PLWH), T cells, viral load, highly active antiretroviral therapy (HAART), exhaustion.

Abbreviation

AIDS: Acquired immune deficiency syndrome; BL: Baseline; CD4: Cluster of differentiation 4; CTLs: cytotoxic T-lymphocytes; FACS: Fluorescence-activated cell sorting; DMSO: dimethyl sulfoxide; HAART: Highly active antiretroviral therapy; HEPES: N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid; HIV: Human immunodeficiency virus; HLA-DR: Human Leukocyte Antigen – DR; ICIs: immune checkpoint inhibitors; IFN-γ: Interferon gamma; IL: interleukin; MUST: Mbarara University of Science and Technology; PCR: Polymerase chain reaction; PBMCs: Peripheral blood mononuclear cells; PBS: phosphate buffered saline; PLWH: People living with HIV; PMA: phorbol myristate acetate; RPMI: Roswell Park Memorial Institute; SD: Standard deviation; UNCST: Uganda National Council for Science and Technology; US: unstimulated; VL: viral load; WHO: World health organization.