title: HIV status, burden of comorbid disease, and biomarkers of inflammation, altered coagulation, and monocyte activation.
abstract: BACKGROUND
  Biomarkers of inflammation, altered coagulation, and monocyte activation are associated with mortality and cardiovascular disease (CVD) in the general population and among human immunodeficiency virus (HIV)-infected people. We compared biomarkers for inflammation, altered coagulation, and monocyte activation between HIV-infected and uninfected people in the Veterans Aging Cohort Study (VACS).
  
  
  METHODS
  Biomarkers of inflammation (interleukin-6 [IL-6]), altered coagulation (d-dimer), and monocyte activation (soluble CD14 [sCD14]) were measured in blood samples from 1525 HIV-infected and 843 uninfected VACS participants. Logistic regression was used to determine the association between HIV infection and prevalence of elevated (>75th percentile) biomarkers, adjusting for confounding comorbidities.
  
  
  RESULTS
  HIV-infected veterans had less prevalent CVD, hypertension, diabetes, obesity, hazardous drinking, and renal disease, but more dyslipidemia, hepatitis C, and current smoking than uninfected veterans. Compared to uninfected veterans, HIV-infected veterans with HIV-1 RNA ≥500 copies/mL or CD4 count <200 cells/µL had a significantly higher prevalence of elevated IL-6 (odds ratio [OR], 1.54; 95% confidence interval [CI],1.14-2.09; OR, 2.25; 95% CI, 1.60-3.16, respectively) and d-dimer (OR, 1.97; 95% CI, 1.44-2.71, OR, 1.68; 95% CI, 1.22-2.32, respectively) after adjusting for comorbidities. HIV-infected veterans with a CD4 cell count <200 cells/µL had significantly higher prevalence of elevated sCD14 compared to uninfected veterans (OR, 2.60; 95% CI, 1.64-4.14). These associations still persisted after restricting the analysis to veterans without known confounding comorbid conditions.
  
  
  CONCLUSIONS
  These data suggest that ongoing HIV replication and immune depletion significantly contribute to increased prevalence of elevated biomarkers of inflammation, altered coagulation, and monocyte activation. This contribution is independent of and in addition to the substantial contribution from comorbid conditions.
authors.affiliation: Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, PA, USA.
authors.forename: Kaku A
authors.initials: KA
authors.lastname: Armah
authors.forename: Kathleen
authors.initials: K
authors.lastname: McGinnis
authors.forename: Jason
authors.initials: J
authors.lastname: Baker
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.forename: Matthew
authors.initials: M
authors.lastname: Goetz
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
authors.forename: Krisann K
authors.initials: KK
authors.lastname: Oursler
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Steve
authors.initials: S
authors.lastname: Crystal
authors.forename: Adam
authors.initials: A
authors.lastname: Gordon
authors.forename: Kevin
authors.initials: K
authors.lastname: Kraemer
authors.forename: Sheldon
authors.initials: S
authors.lastname: Brown
authors.forename: Mariana
authors.initials: M
authors.lastname: Gerschenson
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: Charles
authors.initials: C
authors.lastname: Rinaldo
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Matthew
authors.initials: M
authors.lastname: Freiberg
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001778:Blood Coagulation Disorders / Q000821:virology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D014728:Veterans
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C508600:IL6 protein, human; D015850:Interleukin-6; D018950:Lipopolysaccharide Receptors; C036309:fibrin fragment D