Persistently elevated C-reactive protein level in the first year of antiretroviral therapy, despite virologic suppression, is associated with HIV disease progression in resource-constrained settings

Post Date: 
2016-04-01
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Clinical Sites: 
Publication: 
The Journal of Infectious Diseases
Summary: 
A case-cohort analysis of human immunodeficiency virus (HIV)-infected individuals receiving antiretroviral therapy (ART) was performed within a multicountry randomized trial (PEARLS) to assess the prevalence of persistently elevated C-reactive protein (CRP) levels, based on serial measurements of CRP levels, and their association with HIV clinical failure. A persistently elevated CRP level in plasma (defined as ≥ 5 mg/L at both baseline and 24 weeks after ART initiation) was observed in 50 of 205 individuals (24%). A persistently elevated CRP level but not an elevated CRP level only at a single time point was independently associated with increased clinical failure, compared with a persistently low CRP level, despite achievement of virologic suppression. Serial monitoring of CRP levels could identify individuals who are at highest risk of HIV progression and may benefit from future adjunct antiinflammatory therapies.
Citation: 
Shivakoti R, Yang WT, Berendes S, Mwelase N, Kanyama C, Pillay S, Samaneka W, Santos B, Poongulali S, Tripathy S, Riviere C, Lama JR, Cardoso SW, Sugandhavesa P, Balagopal A, Gupte N, Semba RD, Campbell TB, Bollinger RC, Gupta A; NWCS 319 and PEARLS Study Team. Persistently elevated C-reactive protein level in the first year of antiretroviral therapy, despite virologic suppression, is associated with HIV disease progression in resource-constrained settings. J Infect Dis. 2016 Apr 1;213(7):1074-8. doi: 10.1093/infdis/jiv573
Collaborators: 
  • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre
  • Department of Medicine, University of Witwatersrand, Johannesburg
  • UNC Project-Malawi, Lilongwe, Malawi
  • Durban International Clinical Research Site, Durban University of Technology, South Africa
  • University of Zimbabwe Clinical Research Centre, Harare
  • Hospital Nossa Senhora de Conceição, Porto Alegre
  • YR Gaitonde Center for AIDS Research and Education, Chennai
  • National AIDS Research Institute, Pune, India
  • Les Centres GHESKIO, Port-Au-Prince, Haiti
  • Asociacion Civil Impacta Salud y Educacion, Lima, Peru
  • STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
  • Research Institute for Health Sciences, Chiang Mai, Thailand
  • Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora