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Randomized Controlled Trial
. 2011 Jun 1;203(11):1637-46.
doi: 10.1093/infdis/jir134.

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

David R Boulware  1 , 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; INSIGHT Study Group
Affiliations
Randomized Controlled Trial

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

David R Boulware et al. J Infect Dis. .

Abstract

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.

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Figures

Figure 1.
Figure 1.
Adjusted multivariate odds ratios (with 95% confidence intervals) for AIDS or death, death alone, and immune reconstitution inflammatory syndrome (IRIS) events for selected combinations of biomarkers measured prior to the initiation of antiretroviral therapy (ART). Each odds ratio compares participants with all biomarker values considered above the cohort medians to participants without all biomarker values above the cohort medians.
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