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

Bruno Bezerril Andrade, Katherine Huppler Hullsiek, David R. Boulware, Adam Rupert, Martyn A. French, Kiat Ruxrungtham, Marisa Luisa Montes, Huw Price, Pablo Barreiro, Jennifer Audsley, Alan Sher, Sharon R. Lewin, Irini Sereti

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

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
StatePublished - 1 May 2013
Externally publishedYes

Keywords

  • AIDS
  • biomarkers
  • hepatic flares
  • hepatitis

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