Activation and coagulation biomarkers are independent predictors of the development of opportunistic disease in patients with HIV infection

J Infect Dis. 2009 Sep 15;200(6):973-83. doi: 10.1086/605447.


Background: Activation and coagulation biomarkers were measured within the Strategies for Management of Antiretroviral Therapy (SMART) trial. Their associations with opportunistic disease (OD) in human immunodeficiency virus (HIV)-positive patients were examined.

Methods: Inflammatory (high-sensitivity C-reactive protein [hsCRP], interleukin-6 [IL-6], amyloid-A, and amyloid-P) and coagulation (D-dimer and prothrombin-fragment 1+2) markers were determined. Conditional logistic regression analyses were used to assess associations between these biomarkers and risk of OD.

Results: The 91 patients who developed an OD were matched to 182 control subjects. Patients with an hsCRP level > or =5 microg/mL at baseline had a 3.5 higher odds of OD (95% confidence interval [CI], 1.5-8.1) than did those with an hsCRP level <1 microg/mL (P=.003, by test for trend) and patients with an IL-6 level > or =3 pg/mL at baseline had a 2.4 higher odds of OD (95% CI, 1.0-5.4) than did those with an IL-6 level <1.5 pg/mL (P=.02, by test for trend). No other baseline biomarkers predicted development of an OD. Latest follow-up hsCRP level for those with an hsCRP level > or =5 microg/mL (compared with a level <1 microg/mL; odds ratio [OR], 7.6; 95% CI, 2.0-28.5; [P=.002, by test for trend), latest amyloid-A level for those with an amyloid-A level > or =6 mg/L (compared with a level <2 mg/L; OR, 3.8; 95% CI, 1.1-13.4; P=.03, by test for trend), and latest IL-6 level for those with an IL-6 level > or =3 pg/mL (compared with a level <1.5 pg/mL; OR 2.4; 95% CI, 0.7-8.8; P=.04, by test for trend) were also associated with development of an OD.

Conclusions: Higher IL-6 and hsCRP levels independently predicted development of OD. These biomarkers could provide additional prognostic information for predicting the risk of OD.

Trial registration: NCT00027352.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / metabolism*
  • Adult
  • Anti-HIV Agents
  • Biomarkers*
  • Blood Coagulation / physiology*
  • C-Reactive Protein / metabolism
  • Case-Control Studies
  • Female
  • Humans
  • Inflammation / metabolism*
  • Interleukin-6 / metabolism
  • Male
  • Middle Aged
  • Odds Ratio
  • Risk Factors
  • Serum Amyloid A Protein / metabolism
  • Serum Amyloid P-Component / metabolism


  • Anti-HIV Agents
  • Biomarkers
  • Interleukin-6
  • Serum Amyloid A Protein
  • Serum Amyloid P-Component
  • C-Reactive Protein

Associated data