Inflammation and coagulation in HIV infection contributes significantly to patient mortality

Evaluation of: Kuller LH, Tracey R, Belloso W et al.: Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLOS Med. 5(10), e203 (2008). The authors of this paper investigate a number of biomarkers associated with inflammation (high sensitivity C-reactive protein, IL-6, amyloid A, and amyloid P) and coagulation (D-dimer and prothrombin fragment 1+2) in the Strategies for Management of Antiretroviral Therapy (SMART) trial. In the SMART study an increased risk of all-cause mortality was demonstrated in the therapy interruption arm, as compared with standard practice of continuous antiretroviral treatment. Kuller and colleagues demonstrated that IL-6 and D-dimer levels were strongly associated with all-cause mortality. The authors postulate that HIV leads to activation of inflammation and coagulation increasing the risk of death in HIV-infected individuals and that interrupting antiretroviral treatment increases this risk.