title: Association of markers of hemostasis with death in HIV-infected women.
abstract: : In HIV negatives, markers of hemostasis, including D-dimer, factor VIII, plasminogen activator inhibitor-1 antigen (PAI-1), and total protein S are associated with all-cause and cardiovascular disease mortality. In HIV positives, studies of D-dimer and factor VIII with death were limited to short follow-up; associations of PAI-1 and total protein S with death have not been examined. In 674 HIV-infected women from the Women's Interagency HIV Study, markers from the first visit after enrollment were exposures of interest in multivariate analyses of death (AIDS and non-AIDS) in separate models at 5 and 16 years. There were 87 AIDS and 44 non-AIDS deaths at 5 years, and 159 AIDS and 113 non-AIDS deaths at 16 years. An inverse association of total protein S quartiles with non-AIDS deaths was observed at 5 (P trend = 0.002) and 16 years (P trend = 0.02); there was no association with AIDS deaths. The third quartile of PAI-1 was associated with AIDS deaths at 5 [hazard ratio (HR) = 4.0; 95% confidence interval (CI): 1.9 to 8.4] and 16 years (HR = 3.4; 95% CI: 1.9 to 5.9); and with non-AIDS deaths at 5 years (HR = 4.8; 95% CI: 1.6 to 13.9). D-dimer and factor VIII were not associated with AIDS or non-AIDS death at 5 or 16 years. Lower total Protein S was a consistent marker of non-AIDS death. We found no association between D-dimer with AIDS or non-AIDS death, in contrast to previous studies showing increased short-term (<5 years) mortality, which may represent sex differences or population heterogeneity. Given longer survival on highly active antiretroviral therapy, further studies of these markers are needed to determine their prognostic value.
authors.affiliation: *John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; †Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ; ‡New York Medical College, Valhalla, NY; §Albert Einstein College of Medicine, Bronx, NY; ‖State University at Downstate Medical Center, Brooklyn, NY; ¶Stroger Hospital and Rush University, Chicago, IL; #John Hopkins Bloomberg School of Public Health, Baltimore, MD; **Georgetown University, Washington, DC; ††Los Angeles County and University of Southern California Medical Center, Los Angeles, CA; ‡‡University of California, San Francisco, San Francisco, CA; §§University of Vermont, Burlington, VT; and ‖‖Montefiore Medical Center, Bronx, NY.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kiefer
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kuniholm
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: Chenglong
authors.initials: C
authors.lastname: Liu
authors.forename: Marek
authors.initials: M
authors.lastname: Nowicki
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Tien
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005169:Factor VIII / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D015658:HIV Infections / Q000097:blood / Q000401:mortality*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017293:Protein S / Q000032:analysis; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; D017293:Protein S; C036309:fibrin fragment D; D005169:Factor VIII