title: Elevated Biomarkers of Inflammation and Coagulation in Patients with HIV Are Associated with Higher Framingham and VACS Risk Index Scores.
abstract: BACKGROUND
  Biomarkers of inflammation and altered coagulation are of increasing interest as predictors of chronic disease and mortality in HIV patients, as well as the use of risk stratification scores such as the Framingham index and the Veterans Aging Cohort Study (VACS) score.
  
  
  METHODS
  Demographic and laboratory data for 252 HIV patients were assessed for their relationship with 5 biomarkers: hsCRP, D-dimer, Cystatin C, IL-6 and TNF-alpha. Analysis of variance was used to model the association between the number of elevated biomarkers patients had and their Framingham 10 year cardiovascular risk and VACS scores.
  
  
  RESULTS
  87% of patients were male and 75.7% were virally suppressed (HIV RNA <48 copies/ml). The median and interquartile ranges for each biomarker were: hsCRP 1.65 ug/mL (0.73, 3.89), D-dimer 0.17 ug/mL (0.09, 0.31), Cystatin C 0.87 mg/L (0.78, 1.01), IL-6 2.13 pg/mL (1.3, 3.59), TNF-alpha 4.65 pg/mL (3.5, 5.97). 62.6% of patients had more than one biomarker >75th percentile, while 18.6% had three or more elevated biomarkers. Increased age, cigarette smoking, CD4 counts of <200 cells/mm3, Framingham scores and VACS scores were most strongly associated with elevations in biomarkers. When biomarkers were used to predict the Framingham and VACS scores, those with a higher number of elevated biomarkers had higher mean VACS scores, with a similar but less robust finding for Framingham scores.
  
  
  CONCLUSIONS
  Despite viral suppression and immunological stability, biomarkers of inflammation and coagulation remain elevated in a significant number of patients with HIV and are associated with higher scores on risk stratification indices.
authors.affiliation: Department of Medicine, Infectious Disease Unit, University of Vermont College of Medicine, Burlington, VT, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mooney
authors.affiliation: Department of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, VT, United States of America.
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, VT, United States of America.
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.affiliation: Department of Medicine, Infectious Disease Unit, University of Vermont College of Medicine, Burlington, VT, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Grace
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000209:etiology / Q000821:virology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000821:virology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014707:Vermont; D014728:Veterans
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D