title: Elevated NT-pro-brain natriuretic peptide level is independently associated with all-cause mortality in HIV-infected women in the early and recent HAART eras in the Women's Interagency HIV Study cohort.
abstract: BACKGROUND
  HIV-infected individuals are at increased risk of right and left heart dysfunction. N-terminal-pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac ventricular strain and systolic dysfunction, may be associated with all-cause mortality in HIV-infected women. The aim of this study was to determine if elevated levels of NT-proBNP is associated with increased mortality in HIV-infected women.
  
  
  METHODS
  Prospective cohort study.
  
  
  RESULTS
  We measured NT-proBNP in 936 HIV-infected and 387 age-matched HIV-uninfected women early (10/11/94 to 7/17/97) and 1082 HIV-infected and 448 HIV-uninfected women late (4/1/08 to 10/7/08) in the highly active antiretroviral therapy (HAART) periods in the Women's Interagency HIV Study. An NT-proBNP >75th percentile was more likely in HIV-infected persons, but only statistically significant in the late period (27% vs. 21%, unadjusted p = 0.03). In HIV-infected participants, NT-proBNP>75th percentile was independently associated with worse 5-year survival in the early HAART period (HR 1.8, 95% CI 1.3-2.4, p<0.001) and remained a predictor of mortality in the late HAART period (HR 2.8, 95% CI 1.4-5.5, p = 0.002) independent of other established risk covariates (age, race/ethnicity, body mass index, smoking, hepatitis C serostatus, hypertension, renal function, and hemoglobin). NT-proBNP level was not associated with mortality in HIV-uninfected women.
  
  
  CONCLUSIONS
  NT-proBNP is a novel independent marker of mortality in HIV-infected women both when HAART was first introduced and currently. As NT-proBNP is often associated with both pulmonary hypertension and left ventricular dysfunction, these findings suggest that these conditions may contribute significantly to adverse outcomes in this population, requiring further definition of causes and treatments of elevated NT-proBNP in HIV-infected women.
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Matthew R
authors: MR
authors: Gingo
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Yingze
authors: Y
authors: Zhang
authors: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America.
authors: Kidane B
authors: KB
authors: Ghebrehawariat
authors: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America.
authors: Jong-Hyeon
authors: JH
authors: Jeong
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Yanxia
authors: Y
authors: Chu
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Quanwei
authors: Q
authors: Yang
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Lorrie
authors: L
authors: Lucht
authors: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America.
authors: David B
authors: DB
authors: Hanna
authors: Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, United States of America.
authors: Jason M
authors: JM
authors: Lazar
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and UPMC, Pittsburgh, PA, United States of America.
authors: Mark T
authors: MT
authors: Gladwin
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors: Alison
authors: A
authors: Morris
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain