Longitudinal evaluation of markers of inflammation in HIV‐positive and HIV‐negative Rwandan women

Objectives African women are disproportionately affected by HIV infection and may experience non‐AIDS‐related complications associated with inflammation. High‐sensitivity C‐reactive protein (hsCRP), d‐dimer and transthyretin have been examined as inflammatory markers elsewhere, but it is unclear how...

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Published in:	HIV medicine Vol. 19; no. 10; pp. 734 - 744
Main Authors:	Kiefer, EM, Hoover, DR, Shi, Q, Dusingize, JC, Sinayobye, JD, Anastos, K
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-11-2018
Subjects:	Acquired immune deficiency syndrome Adult AIDS Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral therapy Biomarkers - blood C-Reactive Protein - analysis CD4 antigen Complications Dimers d‐dimer Female Fibrin Fibrinogen Degradation Products - analysis high‐sensitivity C‐reactive protein HIV HIV Infections - drug therapy HIV Infections - pathology Human immunodeficiency virus Humans Infections Inflammation Inflammation - pathology Initiators Longitudinal Studies Markers Middle Aged Prealbumin - analysis Prospective Studies Proteins Rwanda Transthyretin women Young Adult Rwanda high-sensitivity C-reactive protein inflammation transthyretin d-dimer women
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Summary:	Objectives African women are disproportionately affected by HIV infection and may experience non‐AIDS‐related complications associated with inflammation. High‐sensitivity C‐reactive protein (hsCRP), d‐dimer and transthyretin have been examined as inflammatory markers elsewhere, but it is unclear how they change over time in HIV‐negative or HIV‐positive African women with or without antiretroviral therapy (ART) initiation. Methods We examined hsCRP, d‐dimer and transthyretin levels at baseline and at follow‐up of ≥2 years in 185 HIV‐negative and 510 HIV‐positive Rwandan women who were ART naïve at study entry. Generalized estimating equations for each marker were used to investigate the association with HIV infection/CD4 count, ART and follow‐up time. Results Compared with HIV‐negative women, HIV‐positive women had higher hsCRP and d‐dimer and lower transthyretin concentrations, with greater differences at lower CD4 counts. After adjusting for CD4 count and other factors, ART was not significantly associated with log hsCRP (P = 0.36) at follow‐up, but was independently associated with lower log d‐dimer (P = 0.03) and higher transthyretin (P = 0.0008) concentrations. At ≥ 2 years of follow‐up, hsCRP had not significantly changed in any group but log d‐dimer had decreased significantly in all groups. Transthyretin declined significantly over time in HIV‐negative women and HIV‐positive non‐ART initiators, but increased significantly in HIV‐positive ART initiators. Conclusions HIV infection and advanced immune suppression were associated with higher hsCRP and d‐dimer and lower transthyretin concentrations. ART (independently of CD4 changes) was significantly associated with decreases in d‐dimer and increases in transthyretin, but, in contrast to other studies, was not associated with decreases in hsCRP. We found no change in hsCRP over time in any group.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 E.M.K, D.R.H, Q.S., and K.A designed the research study. Q.S and D.R.H. performed statistical tests. E.M.K, D.R.H, Q.S., and K.A analyzed the data. E.M.K wrote the paper. E.M.K, D.R.H, Q.S., J.C.D, J.D.S, and K.A reviewed and edited the paper.
ISSN:	1464-2662 1468-1293
DOI:	10.1111/hiv.12665