Markers of atherosclerosis and inflammation and mortality in patients with HIV infection.
OBJECTIVE
HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. Surrogate marker studies suggest an increased prevalence of vascular abnormalities in HIV infection. We examined the association of all-cause mortality in HIV-infected patients with carotid artery intima-media thickness (cIMT) and high-sensitivity C-reactive protein (hsCRP).


METHODS
Baseline risk factors, cIMT and hsCRP were prospectively measured in 327 HIV-infected participants. Follow-up time with median of 3.1 years was calculated from baseline to death or censored dated 7/31/07. Cox Proportional Hazards models were used to study risk factors associated with mortality.


RESULTS
Thirty-eight (11.6%) of participants have died since study enrollment. cIMT was significantly higher in those who died and decedents were significantly more likely to have cIMT above the 75th percentile. Those who died had higher hsCRP than those alive and more had hsCRP values above 3mg/L. CD4 count was lower and log(10) viral load was higher in decedents, but antiretroviral regimens were similar in both groups. cIMT and hsCRP levels were significantly associated with mortality (HR = 2.74, 95% CI 1.26-5.97, p = 0.01; HR = 2.38, 95% CI 1.15-4.9, p = 0.02).


CONCLUSIONS
Our study demonstrated a strong association of carotid IMT and hsCRP with all-cause death in this HIV-infected population despite being similar with respect to exposure to antiretroviral medications. Together these surrogate markers may be indices of chronic inflammation and unfavorable outcomes in HIV-positive patients.
Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA. alexandra.mangili@tufts.edu
Alexandra
A
Mangili
Joseph F
JF
Polak
Lien A
LA
Quach
Jul
J
Gerrior
Christine A
CA
Wanke
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001900:Boston / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D015854:Up-Regulation
D015415:Biomarkers; D002097:C-Reactive Protein