title: Inflammatory Biomarkers and Mortality Risk Among HIV-Suppressed Men: A Multisite Prospective Cohort Study.
abstract: Human immunodeficiency virus (HIV)-induced inflammation and immune activation persist after initiation of combination antiretroviral therapy (cART) and HIV suppression and may contribute to mortality risks that exceed those in HIV-uninfected populations, though associations are unclear.
  
  
  
  In the prospective Multicenter AIDS Cohort Study, comprising men who have sex with men from Baltimore, Chicago, Los Angeles, and Pittsburgh, concentrations of 24 biomarkers of inflammation and immune activation were measured in stored serum from HIV-positive men obtained after cART-induced HIV suppression between 1996 and 2009. The outcome was nonaccidental death, with follow-up until 2014. We used Cox proportional hazards models to test whether biomarker concentrations predict time from HIV suppression to death and adjusted for multiple tests. Exploratory factor analysis (EFA) was employed to identify groupings of biomarkers that predict mortality risk.
  
  
  
  Of 670 men followed up from HIV suppression, 54 died by the end of 2013. After adjustment for age, CD4(+) cell count, hepatitis B or C virus infection, and smoking, concentrations in the highest quartile of 4 biomarkers were significantly associated with mortality risk after controlling the false discovery rate at 5%: interleukin (IL) 6 (hazard ratio, 3.54; 95% confidence interval, 2.06-6.10), soluble IL 2Rα (3.29, 1.85-5.85), soluble CD14 (2.67, 1.55-4.61), and chemokine (CXC motif) ligand 13 (CXCL13; 2.26; 1.29-3.95). EFA yielded 2 biomarker groupings that were independent predictors of mortality risk.
  
  
  
  Despite having undetectable HIV RNA levels during cART, men with higher concentrations of several biomarkers (particularly IL 6, soluble IL 2Rα, soluble CD14, and CXCL13) had higher hazards of long-term mortality. Correlations observed among biomarker concentrations may represent underlying inflammatory processes that contribute to mortality risk.
authors.affiliation: Department of Epidemiology.
authors.forename: Nikolas I
authors.initials: NI
authors.lastname: Wada
authors.affiliation: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Bream
authors.affiliation: Department of University of California, Los Angeles AIDS Institute.
authors.forename: Otoniel
authors.initials: O
authors.lastname: Martínez-Maza
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Bernard
authors.initials: B
authors.lastname: Macatangay
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Shannon R
authors.initials: SR
authors.lastname: Galvin
authors.affiliation: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Margolick
authors.affiliation: Department of Epidemiology.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood*; D018791:CD4 Lymphocyte Count; D016207:Cytokines / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; D016207:Cytokines
keywords: HIV; biomarkers; cART; inflammation; mortality