Biomarkers of inflammation and coagulation are associated with mortality and hepatitis flares in persons coinfected with HIV and hepatitis viruses

Bruno B Andrade, Katherine H Hullsiek, David R Boulware, Adam Rupert, Martyn A French, Kiat Ruxrungtham, Marisa L Montes, Huw Price, Pablo Barreiro, Jennifer M Audsley, Alan Sher, Sharon Ruth Lewin, Irini Sereti

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28 Citations (Scopus)

Abstract

Background. Hepatitis C virus (HCV) and/or hepatitis B virus (HBV) coinfection with human immunodeficiency virus (HIV) has a greater risk of mortality than either HCV or HBV infection alone and is frequently associated with hepatitis flares after antiretroviral therapy (ART) initiation. Methods. We performed a retrospective cohort study of 287 HIV-positive persons coinfected with HBV and/or HCV (70 had HBV coinfection only, 207 had HCV coninfection only, and 10 had HBV and HCV coinfections) who had pre-ART plasma samples evaluated for biomarkers associated with death (within 4 years) and/or hepatitis flare (within 4 months) after ART initiation. A predictive biomarker risk score was calculated. Results. Forty-eight deaths and 50 hepatitis flares occurred. Nonsurvivors were older, had more prior AIDS-defining events, and had higher pre-ART triglycerides and aspartate transaminase levels. Detectable hyaluronic acid and higher d-dimer, interleukin 6, interleukin 8, and soluble CD14 levels were associated with death in univariate models and with a composite biomarker risk score. The risk of hepatitis flares was higher with HBV coinfection only (24.3 ) and with HBV and HCV coinfection (50 ) than with HCV coinfection only (13.5 ). Higher levels of alanine transaminase and interleukin 10 were also associated with hepatitis flares. Conclusions. Among HIV-positive patients coinfected with HBV and/or HCV who are initiating ART, biomarkers of inflammation and coagulation are associated with an increased risk of death, whereas HBV coinfection and higher pre-ART interleukin 10 levels are associated with hepatitis flares.
Original languageEnglish
Pages (from-to)1379 - 1388
Number of pages10
JournalJournal of Infectious Diseases
Volume207
Issue number9
DOIs
Publication statusPublished - 2013

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