People living with HIV are at increased risk of cardiovascular disease (CVD)(1). Arterial inflammation is heightened in HIV infection, which may explain the high burden of CVD (2). Recently, the CANTOS (Cardiovascular Risk Reduction Study [Reduction in Recurrent Major CV Disease Events]; NCT01327846) trial showed that inflammation reductions achieved through interleukin (IL)-1b inhibition improve CVD outcomes (3). However, it is unclear if an antiinflammatory approach might improve CVD in HIV-infected individuals. This pilot study evaluated the safety of IL-1b inhibition in HIV and tested the hypotheses that IL-1b inhibition reduces immune activation and atherosclerotic plaque inflammation by assessing bone marrow activity and arterial inflammation using fluorodeoxyglucose–positronemission tomography/computed tomography (FDG-PET/CT) alongside multiparametric assessmentsofsystemicinflammationandimmunecell activation.

Ten treated and suppressed HIV-infected individuals with $400 CD4 T-cells/mm3, who were $40 years of age and with established CVD or 1 risk factor received a single subcutaneous dose of 150 mg canakinumab.(Complete inclusion/exclusion criteria are available at NCT02272946). Participants were followed for 12 weeks; FDG-PET/CT was performed at weeks 0 and 8 to measure arterial inflammation and leukopoietic tissue activity. Cryopreserved peripheral blood mononuclear cells were assayed for inflammatory/coagulation markers, immune activation, and monocyte subsets. FDG-PET/CT measurement of arterial inflammation and leukopoietic tissues (bone marrow) has been previously described (4). The University of California, San Francisco Committee on Human Research approved this study; all individuals provided written informed consent.