Mediterranean diet adherence and systemic inflammation in people with HIV and PrEP users.

Background: Chronic low-grade inflammation contributes to long-term morbidity in people with HIV (PWH). Individuals using pre-exposure prophylaxis (PrEP) may share lifestyle factors associated with immune activation. We evaluated whether adherence to the Mediterranean diet, assessed using the Mediterranean Diet Quality Index (MED-DQI), is associated with inflammation in PWH and PrEP users. Methods: We conducted a cross-sectional study of 82 MSM (24 PWH and 58 PrEP users). We calculated MED-DQI from 3-day dietary records and measured 45 plasma cytokines by multiplex immunoassay. Cytokine values were ln-transformed, standardized to Results: Diet quality did not differ between groups (PWH 7.3 ± 1.9; PrEP 7.4 ± 1.6). Participants with lower adherence (MED-DQI ≥ 8) had a higher inflammatory index than those with better adherence (MED-DQI ≤ 7) (mean difference -0.34; 95% CI -0.62 to -0.07; Discussion: Our study found that adherence to the Mediterranean diet was associated with a lower global inflammatory index in both PWH and PrEP users. Lower adherence was associated with higher global inflammatory index values and elevated cytokine concentrations, suggesting differences in systemic immune activation. Even modest differences in diet quality were reflected in variations across the cytokine profile. No differences were observed between groups, suggesting these patterns were more closely associated with diet quality than group status. Diet quality may be a modifiable factor associated with inflammatory profiles. Mediterranean dietary approaches could represent a strategy to address chronic low-grade inflammation.