Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Department of Statistics/Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, USA.
HIV Med. 2018 Nov;19(10):734-744. doi: 10.1111/hiv.12665. Epub 2018 Aug 30.
African women are disproportionately affected by HIV infection and may experience non-AIDS-related complications associated with inflammation. High-sensitivity C-reactive protein (hsCRP), d-dimer and transthyretin have been examined as inflammatory markers elsewhere, but it is unclear how they change over time in HIV-negative or HIV-positive African women with or without antiretroviral therapy (ART) initiation.
We examined hsCRP, d-dimer and transthyretin levels at baseline and at follow-up of ≥2 years in 185 HIV-negative and 510 HIV-positive Rwandan women who were ART naïve at study entry. Generalized estimating equations for each marker were used to investigate the association with HIV infection/CD4 count, ART and follow-up time.
Compared with HIV-negative women, HIV-positive women had higher hsCRP and d-dimer and lower transthyretin concentrations, with greater differences at lower CD4 counts. After adjusting for CD4 count and other factors, ART was not significantly associated with log hsCRP (P = 0.36) at follow-up, but was independently associated with lower log d-dimer (P = 0.03) and higher transthyretin (P = 0.0008) concentrations. At ≥ 2 years of follow-up, hsCRP had not significantly changed in any group but log d-dimer had decreased significantly in all groups. Transthyretin declined significantly over time in HIV-negative women and HIV-positive non-ART initiators, but increased significantly in HIV-positive ART initiators.
HIV infection and advanced immune suppression were associated with higher hsCRP and d-dimer and lower transthyretin concentrations. ART (independently of CD4 changes) was significantly associated with decreases in d-dimer and increases in transthyretin, but, in contrast to other studies, was not associated with decreases in hsCRP. We found no change in hsCRP over time in any group.
非洲女性受 HIV 感染的影响不成比例，并且可能会经历与炎症相关的非艾滋病相关并发症。高敏 C 反应蛋白（hsCRP）、D-二聚体和转甲状腺素蛋白已在其他地方被检查为炎症标志物，但尚不清楚它们在 HIV 阴性或 HIV 阳性、开始或未开始抗逆转录病毒治疗（ART）的非洲女性中随时间如何变化。
我们检查了 185 名 HIV 阴性和 510 名 HIV 阳性卢旺达女性在基线和随访≥2 年时的 hsCRP、D-二聚体和转甲状腺素蛋白水平，这些女性在研究开始时均未接受 ART。使用广义估计方程对每个标志物进行分析，以研究与 HIV 感染/CD4 计数、ART 和随访时间的关联。
与 HIV 阴性女性相比，HIV 阳性女性的 hsCRP 和 D-二聚体水平较高，转甲状腺素蛋白水平较低，在 CD4 计数较低时差异更大。在调整 CD4 计数和其他因素后，ART 与随访时的 log hsCRP 无显著相关性（P=0.36），但与 log D-二聚体降低（P=0.03）和转甲状腺素蛋白升高（P=0.0008）独立相关。在≥2 年的随访中，任何组的 hsCRP 均未显著变化，但所有组的 log D-二聚体均显著降低。在 HIV 阴性女性和未开始 ART 的 HIV 阳性患者中，转甲状腺素蛋白随时间显著下降，但在开始 ART 的 HIV 阳性患者中显著增加。
HIV 感染和免疫抑制严重与较高的 hsCRP 和 D-二聚体以及较低的转甲状腺素蛋白浓度相关。ART（独立于 CD4 变化）与 D-二聚体降低和转甲状腺素蛋白升高显著相关，但与其他研究不同的是，它与 hsCRP 降低无关。我们发现任何一组的 hsCRP 随时间都没有变化。
