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Hart, Brian B.; Nordell, Anna D.; Okulicz, Jason F.; Palfreeman, Adrian; Horban, Andrzej; Kedem, Eynat; Neuhaus, Jacqueline; Jacobs, David R.; Duprez, Daniel A.; Neaton, James D.

Inflammation-Related Morbidity and Mortality Among HIV-Positive Adults: How Extensive Is It?

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  • Medientyp: E-Artikel
  • Titel: Inflammation-Related Morbidity and Mortality Among HIV-Positive Adults: How Extensive Is It?
  • Beteiligte: Hart, Brian B.; Nordell, Anna D.; Okulicz, Jason F.; Palfreeman, Adrian; Horban, Andrzej; Kedem, Eynat; Neuhaus, Jacqueline; Jacobs, David R.; Duprez, Daniel A.; Neaton, James D.
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2018
  • Erschienen in: JAIDS Journal of Acquired Immune Deficiency Syndromes
  • Sprache: Englisch
  • DOI: 10.1097/qai.0000000000001554
  • ISSN: 1525-4135
  • Schlagwörter: Pharmacology (medical) ; Infectious Diseases
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec> <jats:title>Objective:</jats:title> <jats:p>To determine the rate of grade 4, potentially life-threatening events not attributable to AIDS, cardiovascular disease (CVD), or non-AIDS cancer among participants on antiretroviral therapy and to describe associations of these events with interleukin-6 (IL-6) and D-dimer.</jats:p> </jats:sec> <jats:sec> <jats:title>Design:</jats:title> <jats:p>Cohort study.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>HIV-infected participants on antiretroviral therapy (N = 3568) with an HIV-RNA level ≤ 500 copies/mL were followed for grade 4, AIDS, CVD, non-AIDS cancer, and all-cause mortality events. Grade 4 events were further classified masked to biomarker levels as reflecting chronic inflammation–related disease (ChrIRD) or not (non-ChrIRD). Associations of baseline IL-6 and D-dimer with events were studied using Cox models.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Over a median follow-up of 4.3 years, 339 participants developed a grade 4 event (22.9 per 1000 person-years); 165 participants developed a ChrIRD grade 4 event (10.7 per 1000 person-years). Grade 4 events were more common than AIDS (54 participants), CVD (132), and non-AIDS cancer (80) events, any of which developed in 252 participants (17.1 per 1000 person-years). Grade 4 and AIDS events were associated with similar risks of death. Higher IL-6 [hazard ratio (HR) = 1.19 per doubling of biomarker; <jats:italic toggle="yes">P</jats:italic> = 0.003] and D-dimer (HR = 1.23; <jats:italic toggle="yes">P</jats:italic> &lt; 0.001) levels were associated with an increased risk of grade 4 events. IL-6 associations were stronger for ChrIRD (HR = 1.38; <jats:italic toggle="yes">P</jats:italic> &lt; 0.001) than non-ChrIRD grade 4 events (HR = 1.11; <jats:italic toggle="yes">P</jats:italic> = 0.21).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Morbidity and mortality associated with activation of inflammatory and coagulation pathways include conditions other than AIDS, CVD, and non-AIDS cancer events. Effective inflammation-dampening interventions could greatly affect the health of people with HIV.</jats:p> </jats:sec>
  • Zugangsstatus: Freier Zugang