Journal Article

Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy

Grund, Birgit, Cohen, Calvin J., Wolfson, Julian, Lundgren, Jens D., Baker, Jason V, Phillips, Andrew, Deeks, Steven G., Cozzi-Lepri, Alessandro, Neaton, James D., Wentworth, Deborah

2016

Overview

Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6), D-dimer, and high-sensitivity C-reactive protein (hsCRP) levels with serious non-AIDS conditions or death in 3 large cohorts. In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR) adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability) were used to predict risk reductions in serious non-AIDS conditions or death associated with lower \"usual\" levels of IL-6 and D-dimer. Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63), 1.28 (95% CI: 1.14 to 1.44), and 1.17 (95% CI: 1.09 to 1.26) per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower \"usual\" IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46%) in the risk of serious non-AIDS conditions or death if the relationship is causal. Both IL-6 and D-dimer are independently associated with serious non-AIDS conditions or death among HIV-positive adults with suppressed virus. This suggests that treatments that reduce IL-6 and D-dimer levels might substantially decrease morbidity and mortality in patients on suppressive ART. Clinical trials are needed to test this hypothesis.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / Adults / AIDS / AIDS (Disease) / Analysis / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Bioindicators / Biology and Life Sciences / Biomarkers / Biomarkers - blood / C-reactive protein / C-Reactive Protein - metabolism / Care and treatment / Clinical trials / Coagulation / Complications and side effects / Death / Dilution / Endpoint Determination / Epidemiology / Female / Fibrin Fibrinogen Degradation Products - metabolism / Health aspects / Health risks / Highly active antiretroviral therapy / HIV / HIV infections / HIV Seropositivity - blood / HIV Seropositivity - drug therapy / HIV Seropositivity - mortality / Human immunodeficiency virus / Humans / Influence / Interleukin 6 / Interleukin-6 - blood / Kaplan-Meier Estimate / Liver / Liver diseases / Male / Medical research / Medicine and Health Sciences / Middle Aged / Morbidity / Mortality / Physical Sciences / Reduction / Risk / Risk factors / Risk Reduction Behavior / Viruses