HIV Infection, Antiretroviral Therapy Initiation and Longitudinal Changes in Biomarkers of Organ Function

Abstract

Background HIV is associated with end-organ diseases of aging via unclear mechanisms. Longitudinally assessing how HIV infection and ART initiation affect biomarkers of end organ function/disease could clarify these mechanisms. We investigated longitudinal changes in clinical biomarkers following 1) HIV infection and 2) ART initiation with evidence of viral suppression. Methods Cohort: Veterans Aging Cohort Study Virtual Cohort (VACS VC). VACS VC is a longitudinal cohort of HIV infected (HIV+) and race-ethnicity, sex, age, and clinical site-matched uninfected Veterans enrolled in the same calendar year. Inclusion criteria: a negative and successively positive (>six months) HIV antibody test. We used Wilcoxon signed-rank tests to analyze 1) the effect of HIV infection on lipids, renal, hepatic and hematologic/cardiovascular biomarkers and 2)whether ART initiation with HIV-1 RNA<500 cpm reverts any changes back to pre-HIV levels Results 422 Veterans had at least 1 biomarker measurement available prior to HIV infection and prior to ART initiation. 297 had at least 1 biomarker measurement available prior to HIV infection and after ART initiation with evidence of viral suppression. Mean age prior to HIV infection was 43 years. HIV infection was associated with reduction in total cholesterol, HDL cholesterol, LDL cholesterol, serum albumin, ALT, platelet count, hemoglobin and elevation of FIB-4 score and triglycerides. These changes occurred without significant changes in BMI. ART initiation (with HIV-1 RNA<500cpm) did not reverse alteration in triglycerides, LDL cholesterol, hemoglobin, or FIB-4 to pre-HIV infection levels. Conclusions HIV infection is associated with longitudinal changes in serum levels of several biomarkers of end-organ function/disease and mortality. Multiple biomarkers (triglycerides, LDL cholesterol, hemoglobin, and FIB-4) remain altered from levels prior to HIV infection levels even following inititiation of ART and evidence of viral suppression. These results give insights into underlying mechanisms of increased risk for aging-related chronic diseases in the context of HIV infection.

A Comparative Prospective Study of the Effects of Arv on Liver Enzymes in Hiv Positive Patients With HCV Co-Infection and HCV Naïve Patients Attending Art Centre of Jnims, Imphal

“…This reduction in ALT level in the control group was about 25%. Similar findings were also documented in few studies done in different parts of the world, 12,13,14,15 and contradictory findings were also documented in various studies from different parts of the globe. 4,5,6,7,8,16,17 Among the HCV positive HIV patients at the time of initiation of ART and at 6 months after initiation of ART, approximately 84% of the patients having CD4 count less than 200/cu.mm had improved and crossed CD4 count above 200/cu.mm, which shows a remarkable improvement, these findings were supported by various studies done in different parts of the world.…”

“…4,5,6,7,8,16,17 Among the HCV positive HIV patients at the time of initiation of ART and at 6 months after initiation of ART, approximately 84% of the patients having CD4 count less than 200/cu.mm had improved and crossed CD4 count above 200/cu.mm, which shows a remarkable improvement, these findings were supported by various studies done in different parts of the world. 12,13,14,15 And among the HCV negative HIV positive patients, the improvement in CD4 counts after 6 months of initiation of ART were marked by about 90% of the patients crossing CD4 count above 200/cu.mm from pre-ART CD4 count below 200/cu.mm, similar finding is universal and is the basis for ART. 18 …”

Cerebrospinal fluid (CSF) biomarkers of iron status are associated with CSF viral load, antiretroviral therapy, and demographic factors in HIV-infected adults

“…An increasing number of chronic disease complications, such as HIV-associated neurocognitive disorders (HAND), are therefore the focus of current efforts to improve quality of life for HIV-infected (HIV+) individuals. HAND remains disturbingly common despite ART, for reasons that are only partially understood, occurring in 30–60% of unselected HIV+ persons, even when the virus is undetectable [5, 6]. Intensive research has suggested many possible mechanisms and etiologies for HAND, including persistent low-level immune activation and inflammation within the central nervous system (CNS) [4, 7, 8], comorbid conditions [9], and accelerated aging [10], but few of these mechanisms are directly actionable, and effective interventions remain elusive.…”

Lipids profile among ART-naïve HIV infected patients and men who have sex with men in China: a case control study

“…In both ART‑naïve chronic HIV infection (CHI) adult and children patients, low HDL-C was the most frequently observed abnormality and there existed a significant relationship between lipid parameters and viral load [10, 11]. Results from the Veterans Aging Cohort Study showed that HIV infection was associated with decreased TC, HDL-C, LDL-C and elevation of TG, ART initiation did not reverse alteration in TG or LDL-C to pre-HIV infection levels [12]. This suggests that HIV infection may influence lipids regardless of ART status.…”