title: Association of low level viremia with inflammation and mortality in HIV-infected adults.
abstract: BACKGROUND
  Whether HIV viremia, particularly at low levels is associated with inflammation, increased coagulation, and all-cause mortality is unclear.
  
  
  METHODS
  The associations of HIV RNA level with C-reactive protein (CRP), fibrinogen, interleukin (IL)-6 and mortality were evaluated in 1116 HIV-infected participants from the Study of Fat Redistribution and Metabolic Change in HIV infection. HIV RNA level was categorized as undetectable (i.e., "target not detected"), 1-19, 20-399, 400-9999, and ≥ 10,000 copies/ml. Covariates included demographics, lifestyle, adipose tissue, and HIV-related factors.
  
  
  RESULTS
  HIV RNA level had little association with CRP. Categories of HIV RNA below 10,000 copies/ml had similar levels of IL-6 compared with an undetectable HIV RNA level, while HIV RNA ≥ 10,000 copies/ml was associated with 89% higher IL-6 (p<0.001). This association was attenuated by ~50% after adjustment for CD4+ cell count. Higher HIV RNA was associated with higher fibrinogen. Compared to an undetectable HIV RNA level, fibrinogen was 0.6%, 1.9%, 4.5%, 4.6%, and 9.4% higher across HIV RNA categories, respectively, and statistically significant at the highest level (p = 0.0002 for HIV RNA ≥ 10,000 copies/ml). Higher HIV RNA was associated with mortality during follow-up in unadjusted analysis, but showed little association after adjustment for CD4+ cell count and inflammation.
  
  
  CONCLUSIONS
  HIV RNA ≥ 10,000 copies/ml was associated with higher IL-6 and fibrinogen, but lower levels of viremia appeared similar, and there was little association with CRP. The relationship of HIV RNA with IL-6 was strongly affected by CD4 cell depletion. After adjustment for CD4+ cell count and inflammation, viremia did not appear to be substantially associated with mortality risk over 5 years.
authors.affiliation: University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Abigail
authors.initials: A
authors.lastname: Eastburn
authors.forename: Rebecca
authors.initials: R
authors.lastname: Scherzer
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zolopa
authors.forename: Constance
authors.initials: C
authors.lastname: Benson
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
authors.forename: Tri
authors.initials: T
authors.lastname: Do
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000401:mortality / Q000473:pathology / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood
chemical_list: D012367:RNA, Viral; D002097:C-Reactive Protein
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