Association of HIV infection and HIV/HCV coinfection with C-reactive protein levels - The Fat Redistribution and Metabolic Change in HIV Infection (FRAM) study

University of California, San Francisco, San Francisco, CA, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2008; 48(2):142-8. DOI: 10.1097/QAI.0b013e3181685727
Source: PubMed


Inflammation is a potential mechanism to explain the accelerated atherosclerosis observed in HIV- and hepatitis C virus (HCV)-infected persons. We evaluated C-reactive protein (CRP) in HIV-infected and HIV/HCV-coinfected individuals in the era of effective antiretroviral (ARV) therapy.
Cross-sectional study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) cohort and controls from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
CRP levels were measured in 1135 HIV-infected participants from the FRAM cohort and 281 controls from the CARDIA study. The associations of HIV and HIV/HCV infection with CRP levels were estimated by multivariable linear regression.
Compared with controls, HIV monoinfection was associated with an 88% higher CRP level in men (P < 0.0001) but with no difference in women (5%; P = 0.80) in multivariate analysis. CRP levels were not associated with ARV therapy, HIV RNA level, or CD4 cell count. Compared with controls, HIV/HCV coinfection was associated with a 41% lower CRP level in women (P = 0.012) but with no difference in men (+4%; P = 0.90). Among HIV-infected participants, HCV coinfection was associated with 50% lower CRP levels after multivariable analysis (P < 0.0001) in men and women. Greater visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were strongly associated with CRP levels. Among HIV-infected participants, CRP levels were 17% (P < 0.001) and 21% (P = 0.002) higher per doubling of VAT and SAT; among controls, CRP levels were 34% (P < 0.001) and 61% (P = 0.009) higher, respectively.
In the absence of HCV coinfection, HIV infection is associated with higher CRP levels in men. HCV coinfection is associated with lower CRP levels in men and women.

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Available from: Steven B Heymsfield, Dec 15, 2014
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    • "Findings from our study are consistent with those from prior studies investigating the association between HIV/HCV status and TNF-α [27-30], CRP [31,32], IL-10 [30,33], IFN-γ [30,34,36], IL-6 [28] and cystatin C [35]. However, some differences between our work and these prior studies may reflect different biomarker outcome categorization (quartiles versus detection, secretion, or means), HIV/HCV categorization (viremia versus antibody detection, in vitro stimulation with viral proteins) sources of biomarkers (serum versus intrahepatic), referent groups (participants with undetectable HIV and HCV viremia versus HIV or HCV mono-infected participants) and adjustment covariates. "
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    ABSTRACT: Assessing whether hepatitis C (HCV) co-infection with human immunodeficiency virus (HIV) is associated with increased inflammation is complex. The liver, integral to inflammatory biomarker synthesis, is compromised by HCV and alcohol abuse. Using single liver-synthesized biomarkers (e.g. C-reactive protein) to represent inflammation may not be appropriate in HIV/HCV co-infection. We hypothesized that 1) detectable HIV/HCV RNA was independently associated with increased inflammation; 2) a composite inflammation measure describes inflammation differently from single inflammatory biomarkers. We compared inflammation by HIV/HCV group in a cohort of 361 HIV infected participants from the HIV-Longitudinal Interrelationships of Viruses and Ethanol study. Inflammatory biomarkers >75th percentile were considered elevated. Associations between HIV/HCV group and elevated biomarkers were analyzed as a composite measure (inflammatory burden) or individually. We defined inflammatory burden as number of concurrently elevated biomarkers. Biomarkers included interleukin-6 (IL-6), C-reactive protein (CRP), cystatin C, serum amyloid-A (SAA), tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10). Covariates: alcohol, liver fibrosis, comorbidities, CD4 count, antiretroviral therapy, substance use. Detectable HIV and HCV RNA (OR = 2.49; 95%CI = 1.05--5.89) and detectable HCV RNA alone (2.95; 1.08--8.01) were independently associated with increased odds of having a greater inflammatory burden compared to undetectable viremia. Elevated IL-10 (7.79; 1.90--31.97) and TNF-alpha (7.70; 1.42--41.83) were independently associated with detectable HIV and HCV RNA. Elevated IL-10 was also associated with detectable HCV RNA alone (5.51; 1.17, 25.84). Detectable HIV and HCV replication versus undetectable replication was associated with inflammatory burden and certain inflammatory biomarkers independently of alcohol consumption, liver fibrosis and other comorbidities.
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    • "The treatment failure might be affected by the high proportion of IDU and, consequently, the high proportion of HIV/HCV coinfection, which strongly affects patient adherence to HAART treatment. In spite of the fact that the mechanisms through which HCV infection worsens the condition of HIV patients and increases its complications and AIDS-related deaths are not clear, it likely activates immune cells with the CD4 apoptosis marker and causes a severe defect in the immune system [42], decreasing the power of recovery in CD4 T cells after HAART treatment [43]; increasing the production of cryoglobulin by activation of B cells [44], decreasing the production of CRP [45]; and activating the replication of HCV in lymphoid [46] and lymphoblastic [47] tissues as well as in environmental CD4 T cells in HIV patients [48]. The present study revealed that HAART treatment is highly effective in HIV patients in Iran. "
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    • "Also, the presence of HIV has a negative impact on the natural history of HCV since the progression to cirrhosis is higher in coinfected [54, 55]. HCV/HIV coinfection is associated to develop other complications, such as hematologic disorders [56, 57], kidney disease [58, 59], cardiovascular disease [60, 61], and neurologic status [62–65]. "
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