Impact Of HIV Infection And HAART On Markers Of Inflammation And D-dimer And Serum Lipids In HIV-infected Patients

Part One A retrospective study on lipids and C-reactive protein in HIV-Infected patientsObjective To investigate the levels of serum lipids and C-reactive protein (CRP) and explore whether these factors are correlated with CD4+T cells and HAART in HIV-infected patients. Methods Venous blood samples were collected from 348 HIV-infected patients during January 2005 to December 2009 at Shanghai Pubic Health Clinical Center. The CD4+T cells were determined by flow cytometry. Serum lipids were performed on a Roche Modular P800 (Roche Diagnostics), and CRP was assayed by immune analyzer. The data were analysed using Stata 7.0. Results The median absolute CD4+T was 47 (14-165) cells/μl in 348 cases.72 (20.7%) patients had been treated with antiretroviral drugs, and the median time was 6 (1-15.75) months. Highly active antiretroviral therapy (HAART) was associated with higher TC (P=0.029), HDL (P<0.001) and Apo-A1 (P=0.005). Compared to 76 (21.8%) patients with CD4+T>200/μl,272 (78.2%) with CD4+T≤200/μl had lower TC (P=0.002), HDL (P<0.001) and Apo-A1 (P<0.001), whereas the higher CRP was revealed (P<0.001) in those patients. After adjusting for age, sex and cigarette smoking, multiple linear regression analysis showed that current antiretroviral therapy was associated with HDL (β=0.1476, P=0.004) and Apo-Al (p=0.1341, P=0.007) levels, and that CD4+T cells were associated with the levels of TC, HDL, LDL, Apo-A1 and Apo-B. Conclusion The CD4+T cells and antiretroviral therapy were closely associated with serum lipids and CRP values in HIV-infected patients. HAART may improve HDL and Apo-Al levels.Part TwoImpact of HIV infection and HAART on markers of Inflammation and D-dimer and serum Lipids in HIV-infected patientsObjective HIV and HAART may each associated with excess risk of cardiovascular disease. We investigated the levels of inflammation factors, D-dimer and serum lipids at three time points pre-HAART and post-HAART initiation in HIV-infected patients. The aim was to evaluate the risk factors of cardiovascular disease in HIV-infected patients and to explore the impacts of HIV infection and short term HAART on the risk factors. Methods HIV-infected patients naive to HAART were enrolled from February to December 2009 at Shanghai Pubic Health Clinical Center according to the inclusion and exclusion criteria. Clinical data and venous blood samples were collected from AIDS patients and healthy subjects. Plasma sICAM-1, IL-6, D-dimer, leptin and adiponectin were measured by enzyme-linked immunosorbent assay (ELISA). The five markers, fasting serum lipids and glucose values were compared between the two groups. The CD4+T cells, CD8+CD38+/CD8+% and CD8+HLA-DR+/CD8+% were determined by flow cytometry, and plasma HIV copies were detected with fluorescence quantitative PCR among HIV-infected participants. All the above items were investigated again at 24 weeks and 48 weeks after HAART initiation in HIV-infected patients. Spearman correlations between the markers and HIV viral load, CD4+T cells, CD8+CD38+/CD8+%, CD8+HLA-DR+/CD8+% were carrird out in HIV-infected participants at baseline. While the factors between two time periods of patients were compared through mixed model approach. Analyses were conducted using Stata 7.0. Results We enrolled 74 HIV-infected and 25 healthy participants. For patients, the mean absolute CD4+T and HIV RNA were (129±89) cells/μl and (4.47±0.72) 1g copies/ml, respectively. Compared with healthy subjects, the naive patients had higher sICAM-1, D-dimer, leptin and TG values (P<0.001, P<0.001, P=0.004, P<0.001), however, lower adiponectin, TC, HDL and Apo-A1 values (P<0.001, P=0.003, P< 0.001, P<0.001). At baseline, sICAM-1, IL-6, adiponectin and TG tended to correlate with HIV infection. Following HAART initiation, there were large decreases in sICAM-1, D-dimer and leptin, and large increases in adiponectin, TC, HDL and Apo-A1, whereas TG was still at the high level for 64 patients who were followed up on time. In addition, IL-6 and fasting plasma glucose levels were significantly higher. Conclusion Before HAART, HIV infection results in substantial increases in serum sICAM-1, D-dimer, leptin and TG levels, and decreases in serum adiponectin, TC, HDL-C, and Apo-A1 levels. Subsequent short HAART is associated with improving the abnormal markers, whereas little change in TG, but increases IL-6, fasting plasma glucose levels. The relationship of these markers to HIV-mediated cardiovascular disease risk requires further study.