Mediterranean diet adherence is associated with antiviral, neuroimmune, and cardiometabolic proteomic profiles in people with HIV

Background: Dietary patterns can modulate the expression of proteins involved in inflammatory and metabolic pathways in people living with HIV. The aim of this study was to examine whether adherence to the Mediterranean diet is associated with distinct plasma proteomic signatures in PWH on stable antiretroviral therapy. Chronic inflammation persists despite virological suppression, making diet a potential modifiable factor in this setting. Methods: We included 25 adults with HIV on stable antiretroviral therapy. We assessed dietary intake using a 3-day dietary record, and adherence to the Mediterranean diet was evaluated using the Mediterranean diet Quality Index (Med-DQI). We quantified plasma protein expression using Olink proximity extension assay technology. Results: We found that participants with higher adherence to the Mediterranean diet (Med-DQI < 6) showed significantly higher expression of proteins involved in antiviral and mucosal immunity, neuroprotection, and metabolic regulation, including TLR3, JCHAIN, IL18R1, and NTF3. Conversely, lower adherence (Med-DQI ≥ 6) was associated with increased expression of proinflammatory and metabolically adverse proteins such as MMP10 and B4GALT1. Discussion: Our study indicates that healthier dietary patterns are associated with higher expression of proteins linked to antiviral, mucosal, metabolic, and neuroimmune pathways, and with lower expression of proteins previously related to inflammatory or adverse cardiometabolic profiles in people living with HIV. These differences in proteomic signatures may reflect diet-related variation in immune and metabolic pathways, although their clinical implications require further investigation.