 |
|
|
| |
Association of Inflammation and Coagulation with Clinical
Risk in the START Trial ......
|
| |
| |
....."We have previously demonstrated that biomarkers of inflammation and coagulation predict risk for AIDS and SNA events.2, 3"
from Jules: its time for HHS, NIH, OAR to recognize the pressing need for special attention to aging beyond just looking for anti-inflammatories & special support services for patients & their clinics: 80% in NY, SF, Boston & Florida are over age 45, 50% over 50 & 20% over 60
....higher inflammation (IL-6) markers & coagulation markers were found as a risk for cardiovascular disease, AUDS & non AIDS events in both the immediate & deferred groups in START. Regardng IL-6 and CVD risk those who started earlier HAART (with over 500 CD4) had less risk vs those that deferred treatment.
....inflammation is associated with serious non-AIDS events (comorbidities), AIDS & AIDS-death / inflammation persists despite low or high CD4 count, higher CD4 is associated with lower inflammation & less risk for comorbidities, non-AIDS events
....'CD4 of 500 is better, but CD4 of 900 is more better, yet not matter what your CD4 inflammation markers are higher in HIV+ & inflammation markers are associated with higher rid for comorbidities, EXERCISE reduces inflammation!'
.....This analysis did show that patients that deferred therapy tended to have higher IL-6 & D-Dimer, markers for CVD & comorbidities, but they did not compare the benefit of 500CD4 vs 900 CD4. I say 900 CD4 is definitely more protective thab 500 yet even at 900 CD4 inflammation markers will be higher, thus the only protective thing to do is EXERCISE!!! I am going to gym RIGHT NOW !
Reported by Jules Levin
CROI 2017 Feb 14-16 Seattle, WA
Jason V. Baker1,2, Shweta Sharma3, Birgit Grund4, Adam Rupert5, Julia A. Metcalf6, Mauro Schechter7, Paula Munderi8, Inka Aho9, Sean Emery10, Abdel Babiker11, Andrew Phillips12,
Jens Lundgren13, Jim Neaton3 and H. Clifford Lane14 for the INSIGHT START (Strategic Timing of AntiRetroviral Treatment) Study Group
1Department of Medicine, University of Minnesota, Minneapolis, USA; 2Division of Infectious Diseases, Hennepin County Medical Center, Minneapolis, USA; 3Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA; 4School of Statistics, University of Minnesota, Minneapolis, USA;
5Leidos Biomedical Research Inc., Frederick, Maryland, USA; 6National Institute of Allergy and Infectious Diseases, Division of Clinical Research, Bethesda, MD; 7Projeto Praça Onze, Universidade Federal do Rio de Janeiro, Brazil; 8MRC/UVRI Uganda Research Unit, Entebbe, Uganda; 9Division of Infectious Diseases, Helsinki University Hospital, Finland;
10Kirby Institute, University of New South Wales, Sydney, Australia; 11MRC Clinical Trials Unit, University College London, London, UK; 12HIV Epidemiology & Biostatistics Group, University College London, UK; 13CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
CVD = cardiovascular disease (myocardial infarction, stroke, coronary revascularization, CVD-death); IL = interleukin; hsCRP = high sensitivity C-reactive protein; SAA = serum amyloid A; sICAM = soluble intercellular adhesion molecule;
SNA = serious non-AIDS (CVD, end-stage renal disease, decompensated liver disease, non-AIDS cancer); sVCAM = soluble vascular cellular adhesion molecule; TB = tuberculosis.
•HRs were estimated in separate proportional hazards models, pooled across treatment groups, adjusted for age, gender, and treatment group, stratified by geographic location. HRs are per 2x higher biomarker(s), HRs for IL-6 & D-dimer score are per 2x higher of both IL-6 and D-dimer. The IL6 & D-dimer score is defined as 0.33 log2 IL-6 + 0.16 log2 D-dimer.
•Associations of biomarker levels with the risk of events were homogeneous across treatment groups, except for associations of sVCAM with AIDS (higher HR in the deferred group), of sICAM with SNA (higher HR in the immediate group), sICAM and sVCAM with TB (higher HR in the deferred group).
|
| |
|
|
|
|
|
