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
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
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DOI：
10.1093/infdis/jir134
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发表时间：
2011-06-01
影响因子：
6.4
通讯作者：
Sereti, Irini
中科院分区：
文献类型：
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作者：
Boulware, David R.;Hullsiek, Katherine Huppler;Sereti, Irini
背景。尽管 HIV 受到抑制，晚期人类免疫缺陷病毒 (HIV) 患者在接受抗逆转录病毒治疗 (ART) 的第一年仍会出现大量发病率。生物标志物可以识别高危人群。方法。对 ART 前和初始 ART 试验的 1 个月样本进行了与 1-12 个月内艾滋病事件或死亡相关的生物标志物的评估。病例患者 (n = 63) 和对照患者 (n = 126) 在基线 CD4 细胞计数、肝炎状态和随机化日期方面按 1:2 匹配。所有患者的 HIV RNA 水平在 1 个月时均下降 >= 1 log(10)。结果。与对照患者相比，病例患者既往有更频繁的艾滋病事件 (P = .004)，但基线时的 HIV RNA 水平相似。 ART 前和 1 个月 C 反应蛋白 (CRP)、D-二聚体和白细胞介素 6 (IL-6) 水平以及 ART 前透明质酸 (HA) 水平与新发 AIDS 事件或死亡相关（分别为 P 50.0 ng/mL），增加了 AIDS 或死亡的风险（OR，4.6 [95% CI，2.0-10.3]；P < .001）和 IRIS （OR，8.7 [95% CI，2.2-34.8] P = .002）。结论。 ART 前和 1 个月时测量的炎症生物标志物（CRP、IL-6）、凝血（D-二聚体）和组织纤维化（HA）与艾滋病事件、IRIS 或死亡的较高风险相关，需要进行额外的研究作为风险分层策略。
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 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.