Pre‐therapy inflammation and coagulation activation and long‐term CD4 count responses to the initiation of antiretroviral therapy1. Issue 7 (11th May 2015)

• Record Type: Journal Article
• Authors: Achhra, AC; Phillips, A; Emery, S; MacArthur, RD; Furrer, H; De Wit, S; Losso, M; Law, MG; International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) Strategic Management of Antiretroviral Therapy (SMART) and Flexible Initial Retrovirus Suppressive Therapies (FIRST) study groups
• Is Part Of: HIV medicine. Volume 16:Issue 7(2015:Aug.)
• Page Start: 449
• Page End: 454
• Publication Date: 2015-05-11
• Subjects: HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12258
• Languages: English
• ISSNs: 1464-2662

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hiv12258-sec-0001" sec-type="section"> <title>Objectives</title> <p>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.</p> </sec> <sec id="hiv12258-sec-0002" sec-type="section"> <title>Methods</title> <p>Analyses were based on data from the Strategic Management of Antiretroviral Therapy (SMART) trial, an international trial evaluating continuous <italic>vs.</italic> 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.</p> </sec> <sec id="hiv12258-sec-0003" sec-type="section"> <title>Results</title> <p>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 (<italic>P</italic> for trend: CRP, <italic>P</italic> = 0.97; IL‐6, <italic>P</italic> = 0.25; and D‐dimer, <italic>P</italic> = 0.29).</p> </sec> <sec id="hiv12258-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>