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Elevated levels of dangerous biomarkers found in HIV patients
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Individuals with HIV — even those on antiretroviral therapy — had elevated biomarkers of inflammation, coagulation and renal failure compared with the general population, according to study results.
An multi-national group of researchers involved in the Strategies for Management of Anti-Retroviral Therapy (SMART) study and the Multi-Ethnic Study of Atherosclerosis (MESA) study conducted the trial. The researchers noted that prior research indicates that HIV activates inflammatory and coagulation pathways, which could explain why HIV patients face an increased risk of cardiovascular disease, kidney disease, liver disease and non-AIDS–defining malignancies. Despite this, few studies have compared such biomarkers in patients with and without HIV.
Levels of the four biomarkers in patients from the SMART study were compared to median biomarker levels in two large population-based studies of HIV-negative patients. The biomarkers included high-sensitivity C-reactive protein (hsCRP) and interleukin-6, which measure inflammation; D-dimer, which measures coagulation and fibrinolysis; and cystatin C, which measures impaired renal function.
All four biomarkers are associated with cardiovascular disease in the general population and, with the exception of cystatin C, with all-cause mortality in the SMART study.
Levels of hsCRP and IL-6 in 287 SMART study patients aged 33 to 44 years were compared with those of those of 3,231 patients in the same age group from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Overall, hsCRP and IL-6 levels were 55% (P<.001) and 62% (P<.001) higher in the SMART group.
Levels of all four biomarkers were conducted among 494 SMART study patients and 5,386 MESA study patients aged 45 to 76 years. In the SMART group, levels of hsCRP, IL-6, D-dimer and cystatin C were 50%, 152%, 94% and 27% higher, (P<.001, for all).
Even patients on ART who had HIV RNA levels less than 400 copies/mL showed biomarker levels 21% to 60% higher than the general population (P<.001).
“Given the magnitude of the elevations and their association with cardiovascular disease, renal disease, and all-cause mortality in the general population, as well as with all-cause mortality in the SMART study, treatments that target inflammatory and coagulation pathways and decrease hsCRP, IL-6, and D-dimer levels may warrant investigation among patients with HIV infection,” the researchers wrote.
Neuhaus J. J Infect Dis. 2010;201:1788-1795.