Myeloperoxidase Activities Under Highly Effective Host Immunological Control of HIV-1 Disease Progression

 Corresponding author: Tirimisiyu Alani Ogunola Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Myeloperoxidase Activities Under Highly Effective Host Immunological Control of HIV-1 Disease Progression Tirimisiyu Alani Ogunola 1, *, Adesola Oyekunle Oyekale 2, 7, Oyewale Thomas Oyediran 3, Julianah Damola. Morakinyo 4, Makinde Ronke Adunni 5, Abiodun Felix Omolade 1, Taiwo Paul Olagbe 5, Ogra Victor Ogra 5 and Aminat Bukola Kehinde 6 1 Department of Chemical Pathology, Uniosun Teaching hospital Osogbo. 2 Humboldt Research Hub-Centre for Emerging and Re-emerging Infectious Diseases, LAUTECH, Ogbomoso, Nigeria. 3 Positive Impact College, Ibadan. 4 Department of Medical Microbiology and Parasitology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria. 5 Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. 6 department of Biomedical Ethics CIS, Hamad Bin Khalifa University Doha, Qatar. 7 Department of Chemical Pathology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria. World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 Publication history: Received on 17 August 2025; revised on 25 September 2025; accepted on 30 September 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.28.1.3337 Abstract Myeloperoxidase (MPO), a neutrophil-derived enzyme, plays a critical role in oxidative host defense and inflammatory modulation during HIV infection. While untreated HIV and early antiretroviral therapy (ART) phases are associated with increased MPO activity, its behavior under highly effective immunological control remains unclear. This cross-sectional study enrolled 40 participants: 30 HIV-1–infected individuals (10 OFF-HAART, 10 ON-HAART, 10 AIDS progressors) and 10 HIV-negative controls. Socio-demographic, immunological, and biochemical parameters were assessed, and MPO activity was measured by dianisidine-H₂O₂ assay. Correlation and ROC analyses evaluated associations with HIV progression markers. Age and gender significantly associated with HIV stage (p = 0.002 and p = 0.013, respectively), with AIDS progressors predominantly ≤30 years (60%) and male (80%). HAART duration was also significant (p = 0.011), but infection duration showed no difference (p = 0.653). Circulating MPO activity did not differ significantly across groups (p = 0.629), with slightly higher levels in HIV-negative controls (0.11 ± 0.02 U) versus OFF-HAART (0.08 ± 0.02 U), ON-HAART (0.08 ± 0.02 U), and AIDS progressors (0.07 ± 0.02 U). MPO activity inversely correlated with viral load (r = -0.413, p = 0.023), CD8 count (r = -0.335, p = 0.035), and WBC (r = -0.339, p = 0.032), but not CD4 count or IL-8. CD4 strongly correlated negatively with viral load (r = -0.562, p = 0.001) and positively with albumin (r = 0.609, p < 0.001). ROC analysis showed CD4 had the highest predictive accuracy (AUC = 0.895, p = 0.001), while MPO showed fair discrimination (AUC = 0.653, p = 0.180). Despite significant immune perturbations in HIV-positive individuals, systemic MPO activity did not increase compared to controls, possibly reflecting tissue compartmentalization or sampling limitations. However, inverse correlations with viral load suggest a potential role for MPO in immunological control, warranting longitudinal and mechanistic studies. World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 94 Keywords: Myeloperoxidase; HIV-1; Host immunological control; Disease progression; Innate immunity; Oxidative stress; Inflammation 1. Introduction Myeloperoxidase (MPO) is a heme-containing peroxidase enzyme primarily stored in neutrophil azurophilic granules, where it plays a key role in innate immunity by generating potent oxidants such as hypochlorous acid (HOCl) to eliminate pathogens. Beyond its antimicrobial function, MPO and its oxidative products have been implicated in promoting endothelial dysfunction, lipid peroxidation, and chronic inflammatory states, thereby contributing to cardiovascular and metabolic complications (Kargapolova et al., 2021). In the context of HIV-1 infection, persistent immune activation and oxidative stress are well-recognized drivers of disease progression and non-AIDS-related comorbidities, even in individuals on antiretroviral therapy (ART) with long-term viral suppression (Zicari et al., 2019), HIV infection, particularly in ART-naïve individuals, is associated with elevated MPO activity and increased neutrophil oxidative burst, which peak shortly after ART initiation and normalize only after prolonged viral suppression (≥2 years) (Lombardi et al., 2024). Conversely, data from virally suppressed adults including elite controllers suggest that systemic MPO levels may remain comparable to those of HIV-negative individuals, despite evidence of sustained neutrophil extracellular trap (NET) formation and subclinical inflammation (Rodrigues et al., 2023). This discrepancy highlights a critical knowledge gap regarding MPO dynamics under highly effective host immunological control of HIV-1, whether achieved naturally or through potent ART regimens. While ART and elite control reduce viral replication and restore CD4+ T-cell counts, chronic immune activation and oxidative imbalance persist in many individuals (Sarr et al., 2021), contributing to cardiovascular and metabolic complications. MPO, as a major oxidative enzyme, may influence these outcomes, yet its precise role under conditions of strong immunological control remains poorly defined. Clarifying MPO activity under highly effective host immunological control is essential for understanding residual inflammation in HIV infection, refining biomarkers for oxidative stress, and identifying potential therapeutic targets to mitigate comorbidities. Given the growing burden of non-AIDS-related complications in people living with HIV, this investigation holds significant clinical relevance. 2. Materials and method 2.1. Methodology A total of forty participants were enrolled in this study, comprising thirty HIV-1–infected individuals receiving care at the Hope Clinic, State Specialist Hospital, Asubiaro, Osogbo, Osun State, South-Western Nigeria, and ten HIV-negative individuals who served as controls. Among the HIV-positive participants, 50% were on effective oral highly active antiretroviral therapy (HAART), consisting of Tenofovir (300 mg/day), Lamivudine (150 mg/day), and Efavirenz (600 mg/day). Pregnant women and individuals co-infected with tuberculosis and/or hepatitis viruses were excluded. HIVpositive participants who were HAART-naïve were asymptomatic and had CD4+ T-cell counts greater than 200 cells/µL at the time of enrollment. Ethical approval for the study was obtained from the Research Ethics Committee of the Osun State Hospitals Management Board, and written informed consent was secured from all participants. 2.2. Sampling, Processing and Preservation Blood sampling was done by venepunture while using appropriate standard method. Specimen was transported under icecold condition to the laboratory within one hour. Serum was separated from the whole blood by centrifugation at 1,000rpm for ten minutes and stored at -700c plasma was also stored at -700c. 2.3. Determination of Myeloperoxidase Activities MPO activity was determined by a dianisidine-H2O2 method (Bradley et al., 1982), modified for 96-well plates. Briefly, plasma samples (10 μg protein) were added in triplicate to 0.53 mM o-dianisidine dihydrochloride (Sigma) and 0.15 mM H2O2 in 50 mM potassium phosphate buffer (pH 6.0). After incubation for 5 min at room temperature, the reaction was stopped with 30% sodium azide, and the change in absorbance was measured at 460 nm (ε = 11,300 M−1·cm−1). Results were expressed as units of MPO/mg protein, whereby 1 unit of MPO was defined as the amount of enzyme degrading 1 nmol H2O2 per min at 25°C. MPO protein content was determined by ELISA (Chang et al., 2006); 96-well microtiter plates were coated overnight at 4°C with 100-μl serum samples in 0.1 M carbonate buffer, pH 9.6 (1:10 [vol/vol]), and blocked for 2 h at room temperature with 1% nonfat dry milk. Plates were then sequentially incubated with 100 μl each of anti-MPO monoclonal antibody (Abcam) (1:4,000) for 2 h, horseradish peroxidase-labeled IgG antibody (Sigma) (1:5,000) for 1 h, and Sure World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 95 Blue TMB substrate for 20 min. The colorimetric change in absorbance was measured at 650 nm on a SpectraMax 190 microplate reader (Molecular Devices). Haematology parameters were analysed in haematology auto analyser Sysmex KX-21 which analyses using three detector blocks. 2.4. Statistical Analysis Data were analyzed using graph prism version 5 software package (San Diego, CA) to determine Spearman correlation and Fisher's test were used to test the association between two variables. Results were expressed as Mean ± Standard Error of Means (SEM). The level of statistical significance were considered p<0.05. 3. Result The socio-demographic analysis revealed significant associations of HIV status with age (p = 0.002) and gender (p = 0.013). Most HIV-negative and OFF-HAART participants were aged 31–50 years, whereas AIDS progressors were predominantly ≤30 years, and ON-HAART subjects were more often ≥51 years. Males constituted the majority among AIDS progressors, while females predominated in HIV-negative and OFF-HAART groups (table 1). Infection duration showed no significant difference (p = 0.653), although most participants had lived with HIV for 1–10 years. HAART duration varied significantly across groups (p = 0.011), (table 2) presents the immunological and biochemical markers among study groups. The crosstabulation between HIV status groups and MPO activity (high vs. low) revealed no statistically significant association (χ² = 2.020, df = 3, p = 0.568). High MPO activity was most frequent among HIVnegative subjects (15.0%) and least common among AIDS progressors (7.5%), whereas low MPO activity was highest in AIDS progressors (17.5%) and lowest in HIV-negative participants (10.0%). ON-HAART and OFF-HAART groups showed a balanced distribution between high and low MPO activity (12.5% each for ON-HAART; 10.0% and 15.0% for OFF-HAART) (figure 2). A significant correlations was observed between myeloperoxidase (MPO) activity and several HIV-1 disease progression markers. MPO exhibited a negative correlation with CD8 count (r = -0.335, p = 0.035), viral load (r = -0.413, p = 0.023), and WBC (r = -0.339, p = 0.032), suggesting reduced MPO activity is associated with higher viral replication and altered immune cell dynamics. CD4 count was strongly negatively correlated with viral load (r = - 0.562, p = 0.001) but positively correlated with albumin (r = 0.609, p < 0.001), indicating better nutritional status with higher immunity. CD8 count correlated positively with WBC (r = 0.521, p = 0.001) and interleukin-8 (IL-8) (r = 0.427, p = 0.006), reflecting immune activation. IL-8 also correlated positively with WBC (r = 0.330, p = 0.037) and neutrophils (r = 0.346, p = 0.029), emphasizing its role in inflammation (Table 3). Immunological and biochemical parameters across HIV disease stages and MPO activity groups reveals significant differences in CD4 count (p = 0.001), viral load (p = 0.002), and albumin (p = 0.018). CD4 counts were highest among AIDS progressors with low MPO (828.57±67.77) and lowest in OFF-HAART with high MPO (143.75±76.19), indicating severe immunosuppression in untreated patients with elevated oxidative activity. Viral load was markedly higher in OFF-HAART groups compared to ON-HAART, with low MPO individuals showing the greatest viral replication (319,436.83±116,747.96). Albumin levels were generally higher in HIV-negative and AIDS progressor groups compared to OFF-HAART and ON-HAART patients, suggesting a link between hypoalbuminemia and disease stage. Interleukin-8 levels varied widely, being extremely elevated in HIVnegative individuals with low MPO (423.58±139.88) compared to other groups, but this was not statistically significant (p = 0.088). Total protein and globulin showed marked variability, especially in ON-HAART (low MPO), but without significant group differences. WBC, neutrophil, and lymphocyte counts did not differ significantly across groups (Table 4). Table 1 Socio-demographic Characteristics and HIV Status Distribution. Variable Categories HIVNegative n(%) OFFHAART n(%) ONHAART n(%) AIDS (Progressors) n(%) χ² df pvalue Age (years) ≤30 years 0(0.0%) 0(0.0%) 1(10.0%) 6(60.0%) 20.783 6 0.002 31–50 years 9(90.0%) 8(80.0%) 5(50.0%) 3(30.0%) ≥51 years 1(10.0%) 2(20.0%) 4(40.0%) 1(10.0%) Gender Male 3(30.0%) 1(10.0%) 4(40.0%) 8(80.0%) 10.833 3 0.013 Female 7(70.0%) 9(90.0%) 6(60.0%) 2(20.0%) World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 96 Infection Duration (years) 1–10 years – 6(60.0%) 5(50.0%) 11(55.0%) 0.202 1 0.653 11–20 years – 4(40.0%) 5(50.0%) 9(45.0%) HAART Duration (years) <5 years – 6(60.0%) 1(10.0%) 7(35.0%) 11.238 3 0.011 6–10 years – 0(0.0%) 4(40.0%) 4(20.0%) 11–15 years – 4(40.0%) 2(20.0%) 6(30.0%) 16–20 years – 0(0.0%) 3(30.0%) 3(15.0%) Nature of HAART: Tenofovir (300 mg/day), lamivudine (150 mg/day) and Efaviren (600 mg/day) (χ² = 2.020, df = 3, p = 0.568). Figure 1 Myeloperoxidase activities among the study group Table 2 Immunological and Biochemical Markers among Study Groups Parameter HIV Negative Subjects OFF-HAART Subjects ON-HAART Subjects AIDS Subjects (Progressors) p-Value CD4 (cells/µL) 603.80 ± 69.18 166.10 ± 41.40 395.20 ± 61.69 782.60 ± 60.41 0.000 % CD4 6.04 ± 0.69 1.66 ± 0.41 3.95 ± 0.62 7.83 ± 0.60 0.000 Viral Load (copies/mL) 4202.70 ± 716.26 299173.90 ± 72209.63 171861.80 ± 57852.45 – 0.002 WBC (cells/µL) 4480.00 ± 460.87 4460.00 ± 543.90 4290.00 ± 498.32 3920.00 ± 367.21 0.824 Neutrophil (%) 46.20 ± 5.06 50.10 ± 5.76 41.00 ± 4.32 40.30 ± 4.30 0.455 Absolute Neutrophil 2123.40 ± 353.88 2366.10 ± 433.31 1794.00 ± 303.98 1584.80 ± 232.80 0.385 Lymphocyte (%) 53.80 ± 5.06 49.90 ± 5.76 59.00 ± 4.32 59.70 ± 4.30 0.455 Interleukin-8 (pg/mL) 175.89 ± 84.58 211.14 ± 64.55 125.08 ± 39.73 11.40 ± 1.14 0.088 World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 97 Myeloperoxidase U 0.11 ± 0.02 0.08 ± 0.02 0.08 ± 0.02 0.07 ± 0.02 0.629 Total Protein (g/dL) 80.59 ± 3.51 79.15 ± 3.93 167.99 ± 80.84 85.28 ± 5.83 0.349 Albumin (g/dL) 56.46 ± 1.64 49.43 ± 2.88 52.84 ± 1.62 58.59 ± 1.85 0.018 Globulin (g/dL) 24.13 ± 3.57 29.72 ± 4.28 115.15 ± 81.27 27.69 ± 4.15 0.336 Table 3 Association Between Myeloperoxidase Activity and HIV-1 Disease Progression Markers Across Immunological Control Groups MPO CD4 CD8 virallo ad WBC Neutrop hil Lmph ocyte Interl ukin8 Total protei n Album in Globul in MPO r 1 0.03 4 - 0.33 5* -0.413* - 0.33 9* -0.111 0.111 -0.272 -0.139 0.220 -0.152 p 0.83 7 0.03 5 0.023 0.03 2 0.494 0.494 0.089 0.393 0.173 0.348 CD4 r 0.034 1 - 0.04 0 - 0.562** - 0.01 7 -0.194 0.194 - 0.326* -0.045 0.609** -0.077 p 0.837 0.80 8 0.001 0.91 9 0.230 0.230 0.040 0.782 0.000 0.638 CD8 r -0.335* - 0.04 0 1 -0.256 0.52 1** 0.025 -0.025 .427** -0.036 -0.289 -0.021 p 0.035 0.80 8 0.173 0.00 1 0.879 0.879 0.006 0.827 0.071 0.898 virallo ad r -0.413* - 0.56 2** - 0.25 6 1 - 0.00 8 0.310 -0.310 -0.112 0.261 -0.173 0.267 p 0.023 0.00 1 0.17 3 0.96 7 0.096 0.096 0.555 0.164 0.361 0.153 WBC r -0.339* - 0.01 7 0.52 1** -0.008 1 0.290 -0.290 0.330* -0.179 -0.182 -0.168 p 0.032 0.91 9 0.00 1 0.967 0.069 0.069 0.037 0.269 0.262 0.299 Neutr ophil r -0.111 - 0.19 4 0.02 5 0.310 0.29 0 1 - 1.000** 0.346* 0.051 -0.174 0.059 p 0.494 0.23 0 0.87 9 0.096 0.06 9 0.000 0.029 0.757 0.282 0.718 Lmph ocyte r 0.111 0.19 4 - 0.02 5 -0.310 - 0.29 0 -1.000** 1 - 0.346* -0.051 0.174 -0.059 p 0.494 0.23 0 0.87 9 0.096 0.06 9 0.000 0.029 0.757 0.282 0.718 World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 98 Interlu kin8 r -0.272 - 0.32 6* 0.42 7** -0.112 0.33 0* 0.346* -0.346* 1 -0.105 -0.222 -0.094 p 0.089 0.04 0 0.00 6 0.555 0.03 7 0.029 0.029 0.518 0.169 0.565 Totalp rotein r -0.139 - 0.04 5 - 0.03 6 0.261 - 0.17 9 0.051 -0.051 -0.105 1 -0.085 .998** p 0.393 0.78 2 0.82 7 0.164 0.26 9 0.757 0.757 0.518 0.603 0.000 Album in r 0.220 0.60 9** - 0.28 9 -0.173 - 0.18 2 -0.174 0.174 -0.222 -0.085 1 -0.139 p 0.173 0.00 0 0.07 1 0.361 0.26 2 0.282 0.282 0.169 0.603 0.391 Globul in r -0.152 - 0.07 7 - 0.02 1 0.267 - 0.16 8 0.059 -0.059 -0.094 0.998** -0.139 1 p 0.348 0.63 8 0.89 8 0.153 0.29 9 0.718 0.718 0.565 0.000 0.391 *. Correlation is significant at the 0.05 level (2-tailed); **. Correlation is significant at the 0.01 level (2-tailed). The distribution of age, gender, and HAART duration across MPO categories shows no statistically significant associations (p > 0.05 in all cases). For age, most HIV-negative individuals with high MPO were within 31–50 years (60.0%), while OFF-HAART and ON-HAART groups also had higher representation in this age range, with minimal variation between high and low MPO. Among AIDS progressors, younger individuals (≤30 years) were more common in the low MPO group (50.0%). Gender distribution was generally skewed toward females in HIV-negative, OFF-HAART, and ON-HAART groups, while AIDS progressors were predominantly male, particularly in the low MPO category (60.0%). HAART duration showed no clear trend; however, ON-HAART participants with high MPO were slightly more represented in the 11–15 years category (30.0%), while those with low MPO were more frequent in the <5 years category (40.0%). Similarly, among AIDS progressors, low MPO individuals were more distributed across longer treatment durations (6–20 years) (Table 5).The AUC analysis indicates that CD4 count demonstrated the strongest predictive performance for HIV-1 progression (AUC = 0.895, p = 0.001), followed by albumin with moderate accuracy (AUC = 0.690, p = 0.095). Myeloperoxidase (MPO) showed fair discrimination (AUC = 0.653, p = 0.180), while viral load performed poorly (AUC = 0.100, p < 0.001, indicating inverse prediction). Other markers, including WBC, neutrophils, lymphocytes, interleukin-8, total protein, and globulin, had low AUC values (≤0.513), indicating minimal predictive value (Table 6). World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 99 Table 4 Comparison of Immunological and Biochemical Parameters across Group Parameter HIV Negative (High MPO) HIV Negative (Low MPO) OFF-HAART (High MPO) OFF-HAART (Low MPO) ON-HAART (High MPO) ON-HAART (Low MPO) AIDS Progressor s (High MPO) AIDS Progressor s (Low MPO) PVal ue CD4 (cells/µL) 647.00±108. 46 539.00±64.4 8 143.75±76.19 181.00±52.05 531.00±80.96 259.40±36.77 675.33±119. 89 828.57±67.7 7 0.00 1 Viral Load 4554.83±103 7.35 3674.50±100 1.23 268779.50±672 18.16 319436.83±1167 47.96 69383.60±638 34.00 274340.00±757 32.45 - - 0.00 2 WBC (cells/µL) 3583.33±244 .15 5825.00±662 .54 4100.00±1040.0 3 4700.00±652.69 4280.00±934.5 6 4300.00±493.96 3633.33±36 6.67 4042.86±51 1.23 0.82 4 Neutrophil (%) 44.00±7.19 49.50±7.54 38.75±5.59 57.67±7.64 34.80±3.83 47.20±7.09 45.00±6.08 38.29±5.66 0.45 5 Lymphocyte (%) 56.00±7.19 50.50±7.54 61.25±5.59 42.33±7.64 65.20±3.83 52.80±7.09 55.00±6.08 61.71±5.66 0.45 5 Interleukin8 (pg/mL) 10.77±0.40 423.58±139. 88 85.66±57.19 294.80±87.70 118.56±60.67 131.60±58.31 14.01±3.08 10.27±0.84 0.08 8 Myeloperoxi dase 0.15±0.02 0.05±0.01 0.12±0.03 0.05±0.01 0.13±0.02 0.03±0.01 0.15±0.03 0.04±0.01 0.62 9 Total Protein (g/L) 83.24±3.55 76.62±7.21 85.91±6.12 74.64±4.60 92.14±2.50 243.85±162.87 98.44±1.42 79.65±7.42 0.34 9 Albumin (g/L) 57.11±2.63 55.48±1.50 51.15±2.77 48.29±4.60 56.60±0.76 49.08±2.03 59.41±2.33 58.24±2.55 0.01 8 Globulin (g/L) 26.13±4.21 21.14±6.80 34.76±5.89 26.36±5.94 35.53±2.46 194.77±162.93 39.03±0.91 22.84±4.86 0.33 6 World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 100 Table 5 Distribution of Age, Gender, and HAART Duration by MPO Category Variable Categories High MPO Low MPO Total Chi-square (χ²) P-value Age (HIV Negative) 31–50 years 6 (60.0%) 3 (30.0%) 9 (90.0%) 1.667 0.197 51 and above 0 (0.0%) 1 (10.0%) 1 (10.0%) Age (OFF-HAART) 31–50 years 3 (30.0%) 5 (50.0%) 8 (80.0%) 0.104 0.747 51 and above 1 (10.0%) 1 (10.0%) 2 (20.0%) Age (ON-HAART) ≤30 years 0 (0.0%) 1 (10.0%) 1 (10.0%) 2.200 0.333 31–50 years 2 (20.0%) 3 (30.0%) 5 (50.0%) 51 and above 3 (30.0%) 1 (10.0%) 4 (40.0%) Age (AIDS) ≤30 years 1 (10.0%) 5 (50.0%) 6 (60.0%) 2.857 0.240 31–50 years 1 (10.0%) 2 (20.0%) 3 (30.0%) 51 and above 1 (10.0%) 0 (0.0%) 1 (10.0%) Gender (HIV Neg) Male 1 (10.0%) 2 (20.0%) 3 (30.0%) 1.270 0.260 Female 5 (50.0%) 2 (20.0%) 7 (70.0%) Gender (OFF-HAART) Male 0 (0.0%) 1 (10.0%) 1 (10.0%) 0.741 0.389 Female 4 (40.0%) 5 (50.0%) 9 (90.0%) Gender (ON-HAART) Male 3 (30.0%) 1 (10.0%) 4 (40.0%) 1.667 0.197 Female 2 (20.0%) 4 (40.0%) 6 (60.0%) Gender (AIDS) Male 2 (20.0%) 6 (60.0%) 8 (80.0%) 0.476 0.490 Female 1 (10.0%) 1 (10.0%) 2 (20.0%) HAART Duration (ON) < 5 years 2 (20.0%) 4 (40.0%) 6 (60.0%) 1.667 0.197 11–15 years 3 (30.0%) 1 (10.0%) 4 (40.0%) HAART Duration (AIDS) < 5 years 0 (0.0%) 1 (10.0%) 1 (10.0%) 0.873 0.832 6–10 years 1 (10.0%) 3 (30.0%) 4 (40.0%) 11–15 years 1 (10.0%) 1 (10.0%) 2 (20.0%) 16–20 years 1 (10.0%) 2 (20.0%) 3 (30.0%) World Journal of Advanced Research and Reviews, 2025, 28(01), 093-104 101 Figure 2 Receiver Operating Characteristic (ROC) Analysis of MPO and Immunological Markers Table 6 Area Under the Curve (AUC) Analysis: Predictive Performance of MPO and Immunological Markers in HIV-1 Progression Test Result Variable(s) Area Std. Errora Asymptotic Sig.b Asymptotic 95% Confidence Interval Lower Bound Upper Bound Myeloperoxidase 0.653 0.108 0.180 0.441 0.864 CD4 0.895 0.058 0.001 0.782 10.000 viralload 0.100 0.055 0.000 0.000 0.208 WBC 0.513 0.110 0.912 0.296 0.729 Neutrophil 0.495 0.111 0.965 0.276 0.714 Lmphocyte 0.505 0.111 0.965 0.286 0.724 Interlukin8 0.285 0.138 0.059 0.014 0.556 Totalprotein 0.395 0.110 0.356 0.180 0.610 Albumin 0.690 0.097 0.095 0.500 0.880 Globulin 0.290 0.107 0.065 0.079 0.501 4. Discussion The socio-demographic table reveals that age and gender significantly associate with HIV disease stage: individuals aged ≤30 years are disproportionately represented among AIDS progressors (60 %), with none in negative or off-HAART groups (χ² = 20.783, df = 6, p = .002), while those aged 31–50 years are more prevalent among HIV-negative (90 %) and OFF-HAART (80 %) groups; gender likewise shows males more common among AIDS progressors (80 %) compared to females (20 %; χ² = 10.833, df = 3, p = .013). These demographic distributions may reflect underlying immunological differences influencing host control. Notably, myeloperoxidase (MPO) activity, a key marker of neutrophil activation, has been implicated in HIV progression: Rehman et al. (2023) observed elevated MPO activity and neutrophil oxidative burst in untreated HIV and early ART, normalizing after ≥2 years of therapy, suggesting heightened innate immune activation during disease advancement (Rehman et al., 2023). Moreover, studies indicate that HIV-1 can be captured