Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy

• Published in: PloS one 2016-05, Vol.11 (5), p.e0155100-e0155100
• Main Authors: Grund, Birgit, Baker, Jason V, Deeks, Steven G, Wolfson, Julian, Wentworth, Deborah, Cozzi-Lepri, Alessandro, Cohen, Calvin J, Phillips, Andrew, Lundgren, Jens D, Neaton, James D
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; AIDS (Disease); Analysis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Bioindicators; Biology and Life Sciences; Biomarkers; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Care and treatment; Clinical trials; Coagulation; Complications and side effects; Death; Dilution; Endpoint Determination; Epidemiology; Female; Fibrin Fibrinogen Degradation Products - metabolism; Health aspects; Health risks; Highly active antiretroviral therapy; HIV; HIV infections; HIV Seropositivity - blood; HIV Seropositivity - drug therapy; HIV Seropositivity - mortality; Human immunodeficiency virus; Humans; Influence; Interleukin 6; Interleukin-6 - blood; Kaplan-Meier Estimate; Liver; Liver diseases; Male; Medical research; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Physical Sciences; Reduction; Risk; Risk factors; Risk Reduction Behavior; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0155100

Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6), D-dimer, and high-sensitivity C-reactive protein (hsCRP) levels with serious non-AIDS conditions or death in 3 large cohorts. In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR) adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability) were used to predict risk reductions in serious non-AIDS conditions or death associated with lower "usual" levels of IL-6 and D-dimer. Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63), 1.28 (95% CI: 1.14 to 1.44), and 1.17 (95% CI: 1.09 to 1.26) per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower "usual" IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46%) in the risk of serious non-AIDS conditions or death if the relationship is causal. Both IL-6 and D-dimer are independently associated with serious non-AIDS conditions or death among HIV-positive adults with suppressed virus. This suggests that treatments that reduce IL-6 and D-dimer levels might substantially decrease morbidity and mortality in patients on suppressive ART. Clinical trials are needed to test this hypothesis.