Document Detail


Higher levels of CRP, D-dimer, IL-6, and hyaluronic acid before initiation of antiretroviral therapy (ART) are associated with increased risk of AIDS or death.
MedLine Citation:
PMID:  21592994     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Substantial morbidity occurs during the first year of antiretroviral therapy (ART) in persons with advanced human immunodeficiency virus (HIV) disease despite HIV suppression. Biomarkers may identify high-risk groups.
METHODS: Pre-ART and 1-month samples from an initial ART trial were evaluated for biomarkers associated with AIDS events or death within 1-12 months. Case patients (n = 63) and control patients (n = 126) were 1:2 matched on baseline CD4 cell count, hepatitis status, and randomization date. All had ≥ 1 log(10) HIV RNA level decrease at 1 month.
RESULTS: Case patients had more frequent prior AIDS events, compared with control patients (P = .004), but similar HIV RNA levels at baseline. Pre-ART and 1-month C-reactive protein (CRP), D-dimer, and interleukin 6 (IL-6) levels and pre-ART hyaluronic acid (HA) levels were associated with new AIDS events or death (P ≤ .01). Patients who experienced immune reconstitution inflammatory syndrome (IRIS) events had higher pre-ART tumor necrosis factor α (TNF-α) and HIV RNA levels and significant 1-month increases in CRP, D-dimer, IL-6, interleukin 8, CXCL10, TNF-α, and interferon-γ levels, compared with patients who experienced non-IRIS events (P ≤ .03). Individuals with baseline CRP and HA levels above the cohort median (>2.1 mg/L and >50.0 ng/mL, respectively) had increased risk of AIDS or death (OR, 4.6 [95% CI, 2.0-10.3]; P < .001) and IRIS (OR, 8.7 [95% CI, 2.2-34.8] P = .002).
CONCLUSIONS: Biomarkers of Inflammation (CRP, IL-6), coagulation (D-dimer), and tissue fibrosis (HA) measured pre-ART and at 1 month are associated with higher risk of AIDS events, IRIS, or death, warranting additional study as risk stratification strategies.
Authors:
David R Boulware; Katherine Huppler Hullsiek; Camille E Puronen; Adam Rupert; Jason V Baker; Martyn A French; Paul R Bohjanen; Richard M Novak; James D Neaton; Irini Sereti;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of infectious diseases     Volume:  203     ISSN:  1537-6613     ISO Abbreviation:  J. Infect. Dis.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-19     Completed Date:  2011-08-08     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0413675     Medline TA:  J Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1637-46     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / blood*,  drug therapy
Adult
Anti-Retroviral Agents / therapeutic use
Biological Markers / blood,  metabolism
C-Reactive Protein / metabolism*
Case-Control Studies
Disease Progression
Female
Fibrin Fibrinogen Degradation Products / metabolism*
HIV Infections / blood*,  drug therapy*
Humans
Hyaluronic Acid / blood*
Immune Reconstitution Inflammatory Syndrome / blood,  virology
Interleukin-6 / blood*
Male
Middle Aged
Morbidity
RNA, Viral / blood
Risk Factors
Grant Support
ID/Acronym/Agency:
K12RR023247-05/RR/NCRR NIH HHS; K23 AI073192-03/AI/NIAID NIH HHS; K23 AI073192-04/AI/NIAID NIH HHS; K23AI073192-02/AI/NIAID NIH HHS; L30 AI066779-05/AI/NIAID NIH HHS; MC_U122886352//Medical Research Council; U01AI042170/AI/NIAID NIH HHS; U01AI046362/AI/NIAID NIH HHS; U01AI068641/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/IL6 protein, human; 0/Interleukin-6; 0/RNA, Viral; 0/fibrin fragment D; 9004-61-9/Hyaluronic Acid; 9007-41-4/C-Reactive Protein
Comments/Corrections

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