d-Dimer and CRP levels are elevated prior to antiretroviral treatment in patients who develop IRIS.
Biomarkers could be useful in evaluating immune reconstitution inflammatory syndrome (IRIS). A cohort of 45 HIV-1-infected, antiretroviral treatment (ART)-naive patients with baseline CD4 T cell counts <or=100 cells/microL who were started on ART, suppressed HIV-RNA to <50 copies/mL, and seen every 1-3 months for 1 year were retrospectively evaluated for suspected or confirmed IRIS. d-Dimer, C-reactive protein (CRP), and selected autoantibodies were analyzed at baseline, 1 and 3 months post-ART in cryopreserved plasma. Median differences between cases and controls were compared with Mann-Whitney and Fisher's exact tests. Sixteen patients (35.6%) developed IRIS (median of 35 days post-ART initiation): unmasking=8, paradoxical=7, autoimmune=1. Pre-ART d-dimer and CRP were higher in IRIS cases versus controls (d-dimer: 0.89 mg/L versus 0.66 mg /L, p=0.037; CRP: 0.74 mg/L versus 0.39 mg/L, p=0.022), while d-dimer was higher in unmasking cases at IRIS onset (2.04 mg/L versus 0.36 mg /L, p=0.05). These biomarkers may be useful in identifying patients at risk for IRIS.
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Brian O
BO
Porter
G Laissa
GL
Ouedraogo
Jessica N
JN
Hodge
Margo A
MA
Smith
Alice
A
Pau
Gregg
G
Roby
Richard
R
Kwan
Rachel J
RJ
Bishop
Catherine
C
Rehm
JoAnn
J
Mican
Irini
I
Sereti
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000276:immunology; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D018791:CD4 Lymphocyte Count; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification; D015234:HLA-A Antigens / Q000235:genetics; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D044966:Anti-Retroviral Agents; D001323:Autoantibodies; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D015234:HLA-A Antigens; C036309:fibrin fragment D; D002097:C-Reactive Protein