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Inflammation, coagulation and cardiovascular disease in HIV-infected individuals

Duprez, DA and Neuhaus, J and Kuller, LH and Tracy, R and Belloso, W and De Wit, S and Drummond, F and Lane, HC and Ledergerber, B and Lundgren, J and Nixon, D and Paton, NI and Prineas, RJ and Neaton, JD (2012) Inflammation, coagulation and cardiovascular disease in HIV-infected individuals. PLoS ONE, 7 (9).

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© 2012 Duprez et al. Background: The SMART study was a trial of intermittent use of antiretroviral therapy (ART) (drug conservation [DC]) versus continuous use of ART (viral suppression [VS]) as a strategy to reduce toxicities, including cardiovascular disease (CVD) risk. We studied the predictive value of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and D-dimer with CVD morbidity and mortality in HIV-infected patients who were enrolled in SMART beyond other measured CVD risk factors.Methods: A blood sample was available in 5098 participants who were enrolled in the SMART study for the measurement of IL-6, hsCRP and D-dimer. Hazard ratios (HR) with 95% CI for CVD events were estimated for each quartile (Q) for each biomarker vs the 1st quartile and for 1 SD higher levels. For both treatment groups combined, unadjusted and adjusted HRs were determined using Cox regression models.Results: There were 252 participants who had a CVD event over a median follow-up of 29 months. Adjusted HRs (95% CI) for CVD for Q4 vs Q1 were 4.65 (2.61, 8.29), 2.10 (1.40, 3.16), and 2.14 (1.38, 3.33) for IL-6, hsCRP and D-dimer, respectively. Associations were similar for the DC and VS treatment groups (interaction p-values were >0.30). The addition of the three biomarkers to a model that included baseline covariates significantly improved model fit (p<0.001). Area under the curve (AUC) estimates improved with inclusion of the three biomarkers in a model that included baseline covariates corresponding to other CVD risk factors and HIV factors (0.741 to 0.771; p<0.001 for difference).Conclusions: In HIV-infected individuals, IL-6, hsCRP and D-dimer are associated with an increased risk of CVD independent of other CVD risk factors. Further research is needed to determine whether these biomarkers can be used to improve CVD risk prediction among HIV positive individuals.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Duprez, DA
Neuhaus, J
Kuller, LHKullerL@edc.pitt.eduKULLER
Tracy, R
Belloso, W
De Wit, S
Drummond, F
Lane, HC
Ledergerber, B
Lundgren, J
Nixon, D
Paton, NI
Prineas, RJ
Neaton, JD
ContributionContributors NameEmailPitt UsernameORCID
Date: 10 September 2012
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 7
Number: 9
DOI or Unique Handle: 10.1371/journal.pone.0044454
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
Other ID: NLM PMC3438173
PubMed Central ID: PMC3438173
PubMed ID: 22970224
Date Deposited: 19 Oct 2012 21:21
Last Modified: 22 Dec 2018 14:55


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