Pre-therapy inflammation and coagulation activation and long-term CD4 count responses to the initiation of antiretroviral therapy

Achhra, A. C., Phillips, A., Emery, S., MacArthur, R. D., Furrer, H., De Wit, S., Losso, M. and Law, M. G. (2015) Pre-therapy inflammation and coagulation activation and long-term CD4 count responses to the initiation of antiretroviral therapy. HIV Medicine, 16 7: 449-454. doi:10.1111/hiv.12258


Author Achhra, A. C.
Phillips, A.
Emery, S.
MacArthur, R. D.
Furrer, H.
De Wit, S.
Losso, M.
Law, M. G.
Title Pre-therapy inflammation and coagulation activation and long-term CD4 count responses to the initiation of antiretroviral therapy
Journal name HIV Medicine   Check publisher's open access policy
ISSN 1468-1293
1464-2662
Publication date 2015-08-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/hiv.12258
Open Access Status Not yet assessed
Volume 16
Issue 7
Start page 449
End page 454
Total pages 6
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Objectives
Pre-antiretroviral therapy (ART) inflammation and coagulation activation predict clinical outcomes in HIV-positive individuals. We assessed whether pre-ART inflammatory marker levels predicted the CD4 count response to ART.

Methods
Analyses were based on data from the Strategic Management of Antiretroviral Therapy (SMART) trial, an international trial evaluating continuous vs. interrupted ART, and the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial, evaluating three first-line ART regimens with at least two drug classes. For this analysis, participants had to be ART-naïve or off ART at randomization and (re)starting ART and have C-reactive protein (CRP), interleukin-6 (IL-6) and D-dimer measured pre-ART. Using random effects linear models, we assessed the association between each of the biomarker levels, categorized as quartiles, and change in CD4 count from ART initiation to 24 months post-ART. Analyses adjusted for CD4 count at ART initiation (baseline), study arm, follow-up time and other known confounders.

Results
Overall, 1084 individuals [659 from SMART (26% ART naïve) and 425 from FIRST] met the eligibility criteria, providing 8264 CD4 count measurements. Seventy-five per cent of individuals were male with the mean age of 42 years. The median (interquartile range) baseline CD4 counts were 416 (350–530) and 100 (22–300) cells/μL in SMART and FIRST, respectively. All of the biomarkers were inversely associated with baseline CD4 count in FIRST but not in SMART. In adjusted models, there was no clear relationship between changing biomarker levels and mean change in CD4 count post-ART (P for trend: CRP, P = 0.97; IL-6, P = 0.25; and D-dimer, P = 0.29).

Conclusions
Pre-ART inflammation and coagulation activation do not predict CD4 count response to ART and appear to influence the risk of clinical outcomes through other mechanisms than blunting long-term CD4 count gain.
Keyword Antiretroviral therapy
C-reactive protein
CD4 count
Coagulation
D-dimer
Highly active antiretroviral therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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