患有人类免疫缺陷病毒（HIV）的患者（PWH）患病并发症的风险增加，血浆IL-6水平是这些结果中最有力的预测因子之一。托珊单抗（TCZ）阻断IL-6受体，抑制该细胞因子的功能。这是一项为期40周的安慰剂对照、交叉试验（NCT02049437），在此试验中，稳定接受抗逆转录病毒疗法（ART）的PWH随机接受三剂TCZ或相匹配的安慰剂静脉注射。在经过10周的治疗期和12周的清洗期后，参与者被转换到相反的治疗。主要终点是安全性和治疗后C反应蛋白（CRP）和CD4 + T细胞循环的水平。次要终点包括炎症指标和脂质水平的变化。在TCZ治疗期间，有9个与治疗相关的毒副作用（大多数是中性粒细胞减少症），在安慰剂治疗期间有两个。31名34名参与者完成了研究，并纳入了改良意图分析。TCZ降低了PWH中CRP的水平（中位数降低1819.9 ng / ml，p <0.0001;效应大小0.87），并降低了炎症标记物，包括D-二聚体、可溶性CD14和肿瘤坏死因子受体。TCZ治疗后，所有成熟亚型的T细胞循环倾向于减少，但只有纯真CD4 T细胞的差异是显著的。脂质水平（包括与心血管疾病风险相关的脂质类）在TCZ治疗期间增加。TCZ是安全的，可以降低PWH中的炎症，鉴定了IL-6作为预测接受ART治疗的PWH疾病和死亡率的炎症环境的关键驱动因子。TCZ治疗期间脂质升高的临床意义需要进一步研究。© 作者（们）2023。牛津大学出版社代表美国传染病学会出版。版权所有。有关许可，请发送电子邮件至：journals.permissions@oup.com。

People with HIV (PWH) are at increased risk for comorbidities and plasma IL-6 levels are among the most robust predictors of these outcomes. Tocilizumab (TCZ) blocks the receptor for IL-6, inhibiting functions of this cytokine.This was a 40-week placebo controlled, crossover trial (NCT02049437) where PWH on stable antiretroviral therapy (ART) were randomized to receive three monthly doses of TCZ or matching placebo intravenously. Following a 10 week treatment period and a 12 week washout, participants were switched to the opposite treatment. The primary endpoints were safety and post-treatment levels of C-reactive protein (CRP) and CD4+ T cell cycling. Secondary endpoints included changes in inflammatory indices and lipid levels.There were 9 treatment-related toxicities of grade 2 or greater during TCZ administration (mostly neutropenia) and two during placebo administration. Thirty-one of 34 participants completed the study and were included in a modified intent to treat analysis. TCZ reduced levels of CRP (median decrease 1819.9 ng/ml, p<0.0001; effect size 0.87) and reduced inflammatory markers in PWH, including D-dimer, soluble CD14 and tumor necrosis factor receptors. T cell cycling tended to decrease in all maturation subsets after TCZ administration, but was only significant among naïve CD4 T cells. Lipids levels, including lipid classes that have been related to CVD risk, increased during TCZ treatment.TCZ is safe and decreases inflammation in PWH, identifying IL-6 as a key driver of the inflammatory environment that predicts morbidity and mortality in ART-treated PWH. The clinical significance of lipid elevations during TCZ treatment requires further study.© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.