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Longitudinal evaluation of markers of inflammation in HIV ‐positive and HIV ‐negative Rwandan women
Author(s) -
Kiefer EM,
Hoover DR,
Shi Q,
Dusingize JC,
Sinayobye JD,
Anastos K
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12665
Subject(s) - medicine , transthyretin , human immunodeficiency virus (hiv) , c reactive protein , inflammation , d dimer , immunology , antiretroviral therapy , gastroenterology , viral load
Objectives African women are disproportionately affected by HIV infection and may experience non‐ AIDS ‐related complications associated with inflammation. High‐sensitivity C‐reactive protein (hs CRP ), 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 hs CRP , 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/ CD 4 count, ART and follow‐up time. Results Compared with HIV ‐negative women, HIV ‐positive women had higher hs CRP and d ‐dimer and lower transthyretin concentrations, with greater differences at lower CD 4 counts. After adjusting for CD 4 count and other factors, ART was not significantly associated with log hs CRP ( 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, hs CRP 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 hs CRP and d ‐dimer and lower transthyretin concentrations. ART (independently of CD 4 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 hs CRP . We found no change in hs CRP over time in any group.