title: Clinical utility of biomarkers of endothelial activation and coagulation for prognosis in HIV infection: a systematic review.
abstract: BACKGROUND
  HIV infection is associated with vascular dysfunction and adverse cardiovascular outcomes. Our objective was to review the evidence regarding the clinical utility of endothelial activation and coagulation biomarkers for the prognosis of HIV-infected patients.
  
  
  METHODS
  We searched PubMed and Embase for publications using the keywords "HIV" or "HIV infection" and "endothelium" or "coagulation". We reviewed reference lists and hand-searched for additional relevant articles. All clinical studies that enrolled non-pregnant, HIV-infected adults, measured biomarkers reflecting endothelial activation or coagulation, and prospectively evaluated their associations with vascular dysfunction or clinical outcomes were included.
  
  
  RESULTS
  Seventeen studies were identified that fulfilled the inclusion criteria, of which 11 investigated endothelial activation biomarkers and 12 investigated coagulation biomarkers. Biomarkers and outcomes varied widely across studies. Overall, published studies support an association between P-selectin and venous thromboembolism in HIV-infected patients, an association between tissue-type plasminogen activator and death, and associations between D-dimer and several clinical outcomes, including venous thromboembolism, cardiovascular disease, and all-cause mortality.
  
  
  CONCLUSIONS
  Several studies have demonstrated associations between biomarkers of endothelial activation and coagulation and clinically important outcomes in HIV-1 infection. Additional large-scale prospective investigations to determine the utility of endothelial activation and coagulation biomarkers for risk stratification and prediction of adverse outcomes are clearly warranted.
authors.affiliation: Department of Medicine, University of Washington; Seattle, WA, USA. grahamsm@uw.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Regina
authors.initials: R
authors.lastname: Mwilu
authors.forename: W Conrad
authors.initials: WC
authors.lastname: Liles
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000032:analysis*; D001777:Blood Coagulation; D004730:Endothelium, Vascular / Q000503:physiopathology*; D015658:HIV Infections / Q000175:diagnosis / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D011379:Prognosis
chemical_list: D015415:Biomarkers
keywords: HIV; biomarker; coagulation; endothelium; vascular dysfunction