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Factors associated with D-Dimer levels in HIV-Infected individuals

Apetrei, C., Borges, Á.H., O’Connor, J.L., Phillips, A.N., Baker, J.V., Vjecha, M.J., Losso, M.H., Klinker, H., Lopardo, G., Williams, I., Lundgren, J.D. and John, M. (2014) Factors associated with D-Dimer levels in HIV-Infected individuals. PLoS ONE, 9 (3).

Free to read: https://doi.org/10.1371/journal.pone.0090978
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Abstract

Background
Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood.

Methods
In this cross-sectional study, participants in three randomized controlled trials with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4+ count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]), antiretroviral therapy (ART) use, ART regimens, co-morbidities (hepatitis B/C, diabetes mellitus, prior cardiovascular disease), smoking, renal function (estimated glomerular filtration rate [eGFR] and cystatin C) and cholesterol.

Results
Women from all age groups had higher D-dimer levels than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high-density lipoprotein cholesterol were negatively correlated with D-dimer levels.

Conclusions
D-dimer levels increase with age in HIV+ men, but are already elevated in women at an early age due to reasons other than a higher burden of concomitant diseases. In hepatitis B/C co-infected individuals, hepatic fibrosis, but not hepatitis viral load, was associated with higher D-dimer levels.

Publication Type: Journal Article
Murdoch Affiliation: Institute for Immunology and Infectious Diseases
Publisher: Public Library of Science
Copyright: © 2014 Borges et al.
Other Information: Mina John appears courtesy of the Insight Smart and Esprit Study Group and the SILCAAT Scientific Committee
URI: http://researchrepository.murdoch.edu.au/id/eprint/38887
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