title: Country of residence is associated with distinct inflammatory biomarker signatures in HIV-infected patients.
abstract: BACKGROUND
  Inflammation and coagulation biomarkers are independent predictors of morbidity and mortality in HIV-infected patients. The impact of country of residence on these biomarkers is unknown and was investigated in persons at similar stages of HIV infection.
  
  
  METHODS
  Cryopreserved plasma specimens were analysed from 267 ART-naive patients with CD4 cell counts <100 cells/μl from Mexico (n=124) and South Africa (n=143). Biomarkers were compared and dimension reduction analyses were performed to highlight biosignatures according to nationality, gender and tuberculosis co-infection.
  
  
  RESULTS
  Mexican patients were significantly different from South Africans with regard to age, gender, CD4 cell count, haemoglobin, presence of AIDS-defining illness and prevalence of active tuberculosis. After adjusting for baseline characteristics, patients from Mexico had higher levels of IFN-γ, IL-8, and CXCL-10 whereas patients from South Africa had higher levels of fibrinogen, LTB4, P-selectin, protein S, and sCD40 ligand. The effect of country on the profile of biomarker expression was stronger than gender differences and tuberculosis co-infection.
  
  
  CONCLUSIONS
  Inflammation and coagulation biomarkers vary significantly by country. Further studies are needed to evaluate how these differences may contribute to HIV pathogenesis and prognosis in diverse populations and how they can be accounted for in studies using biomarkers as surrogate end points.
authors.affiliation: National Institute of Allergy and Infectious Diseases , National Institutes of Health (NIH) , Bethesda , MD , USA.
authors.forename: Maura
authors.initials: M
authors.lastname: Manion
authors.affiliation: Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil.
authors.forename: Bruno B
authors.initials: BB
authors.lastname: Andrade
authors.affiliation: National Institute of Allergy and Infectious Diseases , National Institutes of Health (NIH) , Bethesda , MD , USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: DerSimonian
authors.affiliation: Leidos Biomedical Inc , Frederick , MD , USA.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Gu
authors.affiliation: Leidos Biomedical Inc , Frederick , MD , USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Rupert
authors.affiliation: Duke Hubert Yeargan Center for Global Health , Duke University , Durham , NC , USA.
authors.forename: Laura W
authors.initials: LW
authors.lastname: Musselwhite
authors.affiliation: Departamento de Infectologia , Instituto Nacional de Ciencias Medicas y Nutricion , Mexico City , Mexico.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Sierra-Madero
authors.affiliation: Departamento de Infectologia, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico; Division de Investigacion, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Belaunzaran-Zamudio
authors.affiliation: University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.affiliation: Case Western Reserve University , Cleveland , OH , USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
authors.affiliation: National Institute of Allergy and Infectious Diseases , National Institutes of Health (NIH) , Bethesda , MD , USA.
authors.forename: Irini
authors.initials: I
authors.lastname: Sereti
keywords: HIV; biomarkers; inflammation; nationality