High levels of IL-6, D-dimer predict serious non-AIDS conditions in HIV
ATLANTA — New data presented here from three large clinical trials suggest that in patients with HIV who have been successful on antiretroviral therapy, increased levels of interleukin-6 and D-dimer were predictors of serious non-AIDS conditions — myocardial infarction, stroke, cancer, and liver and renal diseases.
Birgit Grund, MD, of the University of Minnesota, and colleagues pooled data on patients included in the SMART (n=1,748), ESPRIT (n=1,446) and SILCAAT (n=572) trials. All patients were assigned ART and virologically suppressed. Cox regression models were used to study interleukin-6 (IL-6) and D-dimer levels across the three studies. The researchers developed an “IL-6/D-dimer test score” to compare and assess novel drugs for the ability to reduce inflammation and coagulation in this patient population.
“People living with HIV are not only at risk for AIDS, but also are at increased risk for serious non-AIDS conditions,” Grund said during a press conference. “This increased risk has been at the forefront of AIDS research for years.”
During a median of 4.9 years follow-up, 262 patients developed a non-AIDS event, particularly non-AIDS cancer and cardiovascular disease.
For models with only one biomarker, IL-6 and D-dimer were associated with risk for serious non-AIDS conditions and mortality (HR=0.86 and 0.91 per 25% lower levels; P<.001 for both).
Among models with joint biomarkers, both IL-6 (P<.001) and D-dimer (P=.02) were independently associated with serious non-AIDS conditions and mortality (HR=0.82 for both).
“Patients who had IL-6 levels in the highest quartile at study entry had a 5-year risk of 12% of developing serious AIDS conditions vs. only 3% among those in the lowest quartile,” Grund said.
“At this point and time, we do not know if reducing inflammation and coagulation through interventions really confers clinical benefit. For that, a large randomized trial will be needed.”
For more information:
Grund B. #60. Presented at: 2013 Conference on Retroviruses and Opportunistic Infections; March 3-6; Atlanta.
Disclosure: Grund reports no relevant financial disclosures.