Interleukin 6 is a stronger predictor of clinical events than high-sensitivity C-reactive protein or D-dimer during HIV infection. Journal of Infectious Diseases
Borges et al. for the INSIGHT SMART Study and ESPRIT Groups investigated the associations of several inflammation and coagulation markers with different clinical endpoints. Among 4’304 participants, there were 157 all-cause deaths, 117 non–AIDS-related deaths, 101 AIDS cases, 121 cardiovascular disease (CVD) cases, and 99 non–AIDS-defining malignancies. Higher interleukin 6 (IL-6) levels at study entry were more strongly associated with subsequent risk of non–AIDS-defining end points such as CVD and non–AIDS-defining malignancies, compared with high-sensitivity C-reactive protein (hsCRP) or D-dimer levels. Furthermore, higher IL-6 level was more strongly associated with fatal events than with fatal and nonfatal CVD or non–AIDS-defining malignancies. These findings were broadly consistent after adjustment for confounders and accounting for potential reverse causality.
In conclusion, IL-6 is a stronger predictor of fatal events than of fatal and nonfatal CVD and non–AIDS-defining cancer. There is a need for clinical end point–driven trials to determine whether adjuvant anti-inflammatory and antithrombotic therapies can reduce morbidity and mortality in treated HIV infection.