Abstract
BackgroundElevated high-sensitivity C-reactive protein (hsCRP) increases the risk of cardiovascular disease (CVD) in the general population, but its role as a predictive marker in HIV-positive patients remains unclear. Aim of the study was to evaluate whether hsCRP or other biomarkers are independent predictors of CVD risk in HIV-infected patients.MethodsRetrospective, nested case–control study. HIV-positive men and women (35–69 years of age) receiving combination antiretroviral therapy (cART) were included. Cases (n = 35) had a major CVD event. Controls (n = 74) free from CVD events for at least 5 years from starting ART were matched on diabetes and smoking. HsCRP, D-dimer, P-selectin, interleukin-6 (IL-6), tissue plasminogen activator, plasminogen activator inhibitor-1 levels were measured.ResultsHigh hsCRP was associated with CVD risk, independently of traditional cardiovascular risk factors, HIV replication and the type of ART received at the time of sampling (adjusted odds ratio 8.00 [1.23-51.94] comparing >3.3 mg/L with <0.9 mg/L; P = 0.03). Higher IL-6 and P-selectin levels were also independently associated with increased CVD risk, although the association was weaker than for hsCRP. Higher total cholesterol and lower HDL cholesterol increased CVD risk, independent of hsCRP.ConclusionhsCRP may be a useful additional biomarker to predict CVD risk in HIV-infected patients receiving cART.
Highlights
Elevated high-sensitivity C-reactive protein increases the risk of cardiovascular disease (CVD) in the general population, but its role as a predictive marker in HIV-positive patients remains unclear
Research into CVD risk factors in the general population has identified a number of predictive biomarkers, such as apolipoprotein B, total cholesterol, interleukin-6 (IL-6), serum amyloid A, D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), P-selectin, intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1) and, most importantly, C-reactive protein (CRP) as determined by high sensitivity techniques [24,25,26,27,28,29]
From the analysis using the combined set of early and late samples, we estimated that elevated high-sensitivity C-reactive protein (hsCRP) was associated with increased CVD risk in HIV-positive patients receiving combination antiretroviral therapy (cART) (8-fold risk increase comparing patients with hsCRP levels >3.3 mg/L with those with
Summary
Elevated high-sensitivity C-reactive protein (hsCRP) increases the risk of cardiovascular disease (CVD) in the general population, but its role as a predictive marker in HIV-positive patients remains unclear. HIV-positive men and women (35–69 years of age) receiving combination antiretroviral therapy (cART) were included. Combination antiretroviral therapy (cART) has substantially reduced HIV-related morbidity and mortality [1]. Research into CVD risk factors in the general population has identified a number of predictive biomarkers, such as apolipoprotein B, total cholesterol, interleukin-6 (IL-6), serum amyloid A, D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), P-selectin, intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1) and, most importantly, C-reactive protein (CRP) as determined by high sensitivity techniques (hsCRP) [24,25,26,27,28,29]. HsCRP levels 3.0 mg/L indicate low, average and high CVD risk, respectively [30]
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