title: Biomarkers of inflammation and coagulation are associated with mortality and hepatitis flares in persons coinfected with HIV and hepatitis viruses.
abstract: BACKGROUND
  Hepatitis C virus (HCV) and/or hepatitis B virus (HBV) coinfection with human immunodeficiency virus (HIV) has a greater risk of mortality than either HCV or HBV infection alone and is frequently associated with hepatitis flares after antiretroviral therapy (ART) initiation.
  
  
  METHODS
  We performed a retrospective cohort study of 287 HIV-positive persons coinfected with HBV and/or HCV (70 had HBV coinfection only, 207 had HCV coninfection only, and 10 had HBV and HCV coinfections) who had pre-ART plasma samples evaluated for biomarkers associated with death (within 4 years) and/or hepatitis flare (within 4 months) after ART initiation. A predictive biomarker risk score was calculated.
  
  
  RESULTS
  Forty-eight deaths and 50 hepatitis flares occurred. Nonsurvivors were older, had more prior AIDS-defining events, and had higher pre-ART triglycerides and aspartate transaminase levels. Detectable hyaluronic acid and higher d-dimer, interleukin 6, interleukin 8, and soluble CD14 levels were associated with death in univariate models and with a composite biomarker risk score. The risk of hepatitis flares was higher with HBV coinfection only (24.3%) and with HBV and HCV coinfection (50%) than with HCV coinfection only (13.5%). Higher levels of alanine transaminase and interleukin 10 were also associated with hepatitis flares.
  
  
  CONCLUSIONS
  Among HIV-positive patients coinfected with HBV and/or HCV who are initiating ART, biomarkers of inflammation and coagulation are associated with an increased risk of death, whereas HBV coinfection and higher pre-ART interleukin 10 levels are associated with hepatitis flares.
authors: Immunobiology Section, Laboratory of Parasitic Diseases, and.
authors: Bruno Bezerril
authors: BB
authors: Andrade
authors: Katherine Huppler
authors: KH
authors: Hullsiek
authors: David R
authors: DR
authors: Boulware
authors: Adam
authors: A
authors: Rupert
authors: Martyn A
authors: MA
authors: French
authors: Kiat
authors: K
authors: Ruxrungtham
authors: Marisa Luisa
authors: ML
authors: Montes
authors: Huw
authors: H
authors: Price
authors: Pablo
authors: P
authors: Barreiro
authors: Jennifer
authors: J
authors: Audsley
authors: Alan
authors: A
authors: Sher
authors: Sharon R
authors: SR
authors: Lewin
authors: Irini
authors: I
authors: Sereti
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood*; D001778:Blood Coagulation Disorders; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006509:Hepatitis B / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D006526:Hepatitis C / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers