Monday, May 17, 2010

HIV risks

Michael Carter for Aidsmap (May 17, 2010)

Even with antiretroviral treatment, patients with HIV still have markers indicating increased risk of heart disease and kidney problems

Key biomarkers associated with an increased risk of serious illnesses such as heart disease and kidney dysfunction are elevated in patients with HIV, even when they are taking HIV treatment, a study published in the June 15th edition of the Journal of Infectious Diseases shows.

Investigators compared levels of C-reactive protein, interleukin 6 (IL-6), D-dimer and cystatin C between US HIV-positive patients in the SMART treatment interruption study and patients in two large US studies involving the general population.

Even after taking into account the use of antiretroviral therapy and suppression of viral load, the researchers found that levels of these biomarkers, which are indicators of inflammation, coagulation and renal function, were higher in people with HIV.

Evidence is accumulating that patients with HIV have an increased risk of serious non-AIDS-defining conditions such as cardiovascular disease, kidney dysfunction, liver disease and some cancers. The reasons for this are uncertain, but it has been suggested that infection with HIV causes ongoing inflammation, coagulation and other disturbances.

“In summary”, write the investigators, “we found that markers of inflammation, coagulation, and renal function were elevated in HIV-infected study participants receiving or not receiving antiretroviral therapy, compared with patients in two large population-based studies. Additional research on the reasons for these elevations and the interventions required to lower them is needed.”

The authors of an editorial that accompanied the study noted that the investigators’ research was “carefully performed”, and that “statistical adjustment for covariates failed to attenuate the relationship between the inflammatory biomarkers and HIV infection”.

Ongoing immune activation and inflammation are suggested as the reasons for these findings, and the authors of the editorial state that it is of critical importance to identify the mechanisms underlying this and to find strategies to prevent it occurring.

Reference

Markers of inflammation, coagulation, and renal function are elevated in adults with HIV infection.
Jacqueline Neuhaus, David R. Jacobs, Jr, Jason V. Baker, Alexandra Calmy, Daniel Duprez, Alberto La Rosa, Lewis H. Kuller, Sarah L. Pett, Matti Ristola, Michael J. Ross, Michael G. Shlipak, Russell Tracy, and James D. Neaton, for the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) Strategies for Management of Anti
-Retroviral Therapy (SMART), Multi-ethnic study of Atherosclerosis (MESA), and Coronary Artery Development in Young Adults (CARDIA) Research Groups
Journal of Infectious Diseases 2010; 201:1788–1795 DOI: 10.1086/652749.

Link to JID abstract


Editorial Commentary: Inflammation and complications of HIV disease.
Michael P. Dubé and Fred R. Sattler
Journal of Infectious Diseases 2010; 201:1783–1785 DOI: 10.1086/652751.

Link to JID editorial

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