Pre-ART Levels of Inflammation and Coagulation Markers Are Strong Predictors of Death in a South African Cohort with Advanced HIV Disease

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2012
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Abstract
Background Levels of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and D-dimer predict mortality in HIV patients on antiretroviral therapy (ART) with relatively preserved CD4+ T cell counts. We hypothesized that elevated pre-ART levels of these markers among patients with advanced HIV would be associated with an increased risk of death following the initiation of ART. Methods Pre-ART plasma from patients with advanced HIV in South Africa was used to measure hsCRP, IL-6 and D-dimer. Using a nested case-control study design, the biomarkers were measured for 187 deaths and two controls matched on age, sex, clinical site, follow-up time and CD4+ cell counts. Odds ratios were estimated using conditional logistic regression. In addition, for a random sample of 100 patients, biomarkers were measured at baseline and 6 months following randomization to determine whether ART altered their levels. Results Median baseline biomarkers levels for cases and controls, respectively, were 11.25 vs. 3.6 mg/L for hsCRP, 1.41 vs. 0.98 mg/L for D-dimer, and 9.02 vs. 4.20 pg/mL for IL-6 (all p
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Authors Lotty Ledwaba;Jorge A. Tavel;Paul Khabo;Patrick Maja;Jing Qin;Phumele Sangweni;Xiao Liu;Dean Follmann;Julia A. Metcalf;Susan Orsega;Beth Baseler;James D. Neaton;H. Clifford Lane;for the Project Phidisa Biomarkers Team;
Journal PloS one
Year 2012
DOI
10.1371/journal.pone.0024243
URL
http://dx.doi.org/10.1371/journal.pone.0024243
Keywords
hiv t cells biomarkers antiretroviral therapy hiv infections inflammatory diseases Death rates medical risk factors National Center for Biotechnology Information NCBI NLM MEDLINE humans pubmed abstract nih national institutes of health national library of medicine prognosis research support non-u.s. gov't u.s. gov't non-p.h.s. adult female male N.I.H. Extramural Randomized Controlled Trial follow-up studies case-control studies Cohort Studies biomarkers / blood* hiv infections / mortality* inflammation / blood survival rate antiretroviral therapy hiv infections / complications pmid:22448211 pmc3308955 doi:10.1371/journal.pone.0024243 lotty ledwaba jorge a tavel project phidisa biomarkers team highly active* blood coagulation / physiology* cd4-positive t-lymphocytes hiv / drug effects hiv / physiology* hiv infections / virology inflammation / diagnosis* inflammation / etiology south africa viral load

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