Markers of inflammation and blood-clotting tied to hazards of intermittent HIV treatment

Oct 21, 2008

Episodic treatment of HIV/AIDS with antiretroviral drugs increases the overall risk of death when compared with continuous antiretroviral treatment (ART), but the reasons why have been unknown. Now, researchers have found that higher levels of certain markers of inflammation and blood-clotting are strongly associated with intermittent ART and with a higher risk of death from non-AIDS diseases.

The new report, published in the open access journal PLoS Medicine, is a further analysis of the "Strategies for Management of Antiretroviral Therapy" (SMART) study supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (www3.niaid.nih.gov/news/newsreleases/2006/smart06). SMART, which ended in 2006, compared the standard practice of continuous ART to suppress HIV in infected individuals with episodic ART based on CD4+ T-cell counts. The goal was to determine whether reducing exposure to antiretroviral drugs, which may have toxic side effects and can engender drug resistance, would be equally or more beneficial than suppressing HIV continuously. Unexpectedly, those who received episodic ART were more than twice as likely to develop disease or die, and the study ended early as a result.

Reflecting on this outcome, James D. Neaton, Ph.D., of the University of Minnesota, and his colleagues hypothesized that pausing ART and allowing HIV levels to rise stimulated inflammation and blood clotting in some patients, which could lead to disease or death.

To test their hypothesis, the scientists examined blood samples from the SMART trial for proteins that are biological markers of inflammation and blood clotting. They found that people who began the study with relatively higher levels of the biomarkers interleukin-6 (IL-6) and D-dimer were at greater risk of death than other study participants. They also found that IL-6 and D-dimer levels rose significantly in the intermittent-treatment group compared to the continuous treatment group after just one month of study.

Based on these observations, the authors conclude that HIV-infected patients who have relatively high levels of IL-6 and D-dimer are at greater risk of death. Most of the deaths in SMART were attributed to non-AIDS-related diseases, the authors write, and giving intermittent ART to volunteers who began that study with elevated levels of these biomarkers may have further increased their risk of death.

Article: LH Kuller et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Medicine DOI:10.1371/journal.pmed.0050203 (2008).

Source: NIH/National Institute of Allergy and Infectious Diseases

Explore further: Cell-associated HIV mucosal transmission: The neglected pathway

add to favorites email to friend print save as pdf

Related Stories

2012 movie massacre hung over 'Interview' decision

29 minutes ago

When a group claiming credit for the hacking of Sony Pictures Entertainment threated violence against theaters showing "The Interview" earlier this week, the fate of the movie's big-screen life was all but ...

SDO captures images of two mid-level flares

54 minutes ago

The sun emitted a mid-level flare on Dec. 18, 2014, at 4:58 p.m. EST. NASA's Solar Dynamics Observatory, which watches the sun constantly, captured an image of the event. Solar flares are powerful bursts ...

Report: FBI's anthrax investigation was flawed

1 hour ago

The FBI used flawed scientific methods to investigate the 2001 anthrax attacks that killed five people and sickened 17 others, federal auditors said Friday in a report sure to fuel skepticism over the FBI's ...

Recommended for you

Cambodia orders probe into mass HIV infection

Dec 18, 2014

Cambodian Prime Minister Hun Sen on Thursday ordered a probe into an apparent mass HIV infection believed to have been spread by contaminated needles, as the number of suspected cases passed 100.

A fresh setback for efforts to cure HIV infection

Dec 17, 2014

Researchers are reporting another disappointment for efforts to cure infection with the AIDS virus. Six patients given blood-cell transplants similar to one that cured a man known as "the Berlin patient" have ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.