Inflammation and mortality in HIV-infected adults: analysis of the FRAM study cohort.
OBJECTIVE
To determine the association of inflammatory markers, fibrinogen, and C-reactive protein (CRP), with 5-year mortality risk.


METHODS
Vital status was ascertained in 922 HIV-infected participants from the Study of Fat Redistribution and Metabolic Change in HIV infection. Multivariable logistic regression estimated odds ratios after adjustment for demographic, cardiovascular, and HIV-related factors.


RESULTS
Over a 5-year period, HIV-infected participants with fibrinogen levels in the highest tertile (>406 mg/dL) had 2.6-fold higher adjusted odds of death than those with fibrinogen in the lowest tertile (<319 mg/dL). Those with high CRP (>3 mg/L) had 2.7-fold higher adjusted odds of death than those with CRP <1 mg/L. When stratified by CD4 count category, fibrinogen (as a linear variable) remained independently associated [odds ratio (95% confidence intervals)] per 100 mg/dL increase in fibrinogen: 1.93 (1.57 to 2.37); 1.43 (1.14 to 1.79); 1.43 (1.14 to 1.81); and 1.30 (1.04 to 1.63) for CD4 <200, 200-350, >350 to 500, and >500 cells per microliter, respectively. Higher CRP also remained associated with higher odds of death overall and within each CD4 subgroup.


CONCLUSIONS
Fibrinogen and CRP are strong and independent predictors of mortality in HIV-infected adults. Our findings suggest that even in those with relatively preserved CD4 counts >500 cells per microliter, inflammation remains an important risk factor for mortality. Further investigation should determine whether interventions to reduce inflammation might decrease mortality risk in HIV-infected individuals.
Tien
Phyllis C
PC
Department of Medicine, University of California, San Francisco, San Francisco, CA 94121, USA. ptien@ucsf.edu
Choi
Andy I
AI
Zolopa
Andrew R
AR
Benson
Constance
C
Tracy
Russell
R
Scherzer
Rebecca
R
Bacchetti
Peter
P
Shlipak
Michael
M
Grunfeld
Carl
C
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D018791:CD4 Lymphocyte Count; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D015658:HIV Infections / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
D005340:Fibrinogen; D002097:C-Reactive Protein