Higher levels of Monocyte Distribution Width as a potential flagging parameter of HIV progression: results of a monocentric observational study

Objectives: Monocyte Distribution Width (MDW) is the standard deviation of the mean volume of monocytes and may indicate innate immune activation. We investigated the possible association between MDW values and late HIV diagnosis in consecutive patients. Methods: We retrospectively enrolled newly diagnosed HIV patients admitted to our clinical center. Demographic and clinical characteristics were analyzed. Results: A total of 97 patients were enrolled. Of these, 63% were late presenters and 43% fulfilled the criteria for advanced HIV disease. Continuous measures showed a significant inverse correlation between CD4 T-cell count and MDW. Multivariate analysis showed that MDW≥21.1 (OR:7.45, 2.13-30.54), HIV viral load >5 log (10) c/mL (OR:3.62, 1.04-13.30), blood lymphocytes<2 x103/µL (OR:14.82, 3.19-111.8) and HIV testing without symptoms (OR:0.21, 0.05-0.82) were independently associated with late presentation. Similarly, adjusted ORs for MDW≥22.5 (OR:4.03, 1.28-13.17), blood lymphocytes<1 x103/µL (OR:9.67, 2.19-57.57), age (OR:1.05, 1.00-1.10) and HIV testing without symptoms (OR:0.16, 0.04-0.52) were significantly associated with advanced HIV disease. Conclusions: Our results suggest that MDW may be a potential flagging parameter of innate immune activation in HIV infection. Continuous measurements of MDW showed a significant inverse correlation with CD4 T-cell count. Patients with increased MDW values were more likely to be diagnosed late.