Trends in C-Reactive Protein, D-Dimer, and Fibrinogen during Therapy for HIV-Associated Multidrug-Resistant Tuberculosis

Abstract

HIV-positive adults on treatment for multi drug-resistant tuberculosis (MDR-TB) experience high mortality. Biomarkers of HIV/MDR-TB treatment response may enable earlier treatment modifications that improve outcomes. To determine whether changes in C-reactive protein (CRP), D-dimer, and fibrinogen were associated with treatment outcome among those with HIV/MDR-TB coinfection, we studied 20 HIV-positive participants for the first 16 weeks of MDR-TB therapy. Serum CRP, fibrinogen, and D-dimer were measured at baseline and serially while on treatment. At baseline, all biomarkers were elevated above normal levels, with median CRP 86.15 mg/L (interquartile range [IQR] 29.25-149.32), D-dimer 0.85 µg/mL (IQR 0.34-1.80), and fibrinogen 4.11 g/L (IQR 3.75-6.31). C-reactive protein decreased significantly within 10 days of treatment initiation and fibrinogen within 28 days; D-dimer did not change significantly. Five (25%) participants died after a median of 32 days. Older age (median age of 38 among survivors and 54 among deceased, = 0.008) and higher baseline fibrinogen (3.86 g/L among survivors and 6.37 g/L among deceased, = 0.02) were significantly associated with death. After adjusting for other measured variables, higher CRP concentrations at the beginning of each measurement interval were significantly associated with a higher risk of death during that interval. Trends in fibrinogen and CRP may be useful for evaluating early response to treatment among individuals with HIV/MDR-TB coinfection.

Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: A prospective cohort study

“…Immune activation at baseline [11,49] and failure to resolve or increased immune activation after ART initiation have been described as risk factors for mortality in HIV-associated tuberculosis cohorts [12, 13, 50]. One of these studies was an outpatient cohort study that followed participants with HIV-associated tuberculosis and showed that higher pre-ART levels of MCP-1/CCL2, eotaxin, IL-10, TNF-α, and IL-6 were associated with 6-month mortality.…”

Pulmonary Tuberculosis-Related Ischemic Stroke: A Retrospective Case Control Study

“…Generally, previous studies have demonstrated that tuberculosis may lead to elevated inflammatory factors in the plasma, such as CRP and SF, and may also lead to platelet activation and the development of a systemic hypercoagulable state. [12][13][14]27,28 First, in the present study, the TBRIS group had elevated plasma inflammatory factors, such as CRP and SF, and an increased monocyte percentage compared to the pTB group, which implies that the immune response to tuberculosis infection may be more intensive in TBRIS patients compared to pTB patients. 29 Moreover, a higher MPV was also found in the TBRIS group.…”

“…When pulmonary tuberculosis is active, elevated plasma inflammatory factors, such as C-reactive protein, increased platelet activation and the development of a hypercoagulable state, may be continued. [12][13][14] More importantly, elevated plasma inflammatory factors, such as C-reactive protein, platelet activation and the hypercoagulable state, have been found to contribute not only to an increased risk of ischemic stroke but also to a poor prognosis. [15][16][17][18] As a result, it was hypothesized that active pulmonary tuberculosis may lead to ischemic stroke through elevated plasma inflammatory factors, such as C-reactive protein, platelet activation and/or hypercoagulability, namely TBRIS.…”

Análise epidemiológica, fisiopatológica, clínica e terapêutica da coinfecção HIV/Tuberculose (TB)

“…No que tange ao maior acometimento da coinfecção por HIV e TB, foi evidenciada uma prevalência por pessoas do sexo masculino de baixa escolaridade (MARQUES et al, 2019) (CUDAHY et al, 2018, tendo eles em sua maioria idade entre 20 e 49 anos (WORLD HEALTH ORGANIZATION, 2020). Por sua vez, esses dados podem ser explicados pela maior tendência desse grupo a se afastar dos serviços de saúde e por terem uma maior dificuldade em manter o autocuidado.…”