Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya
Abstract Background Increased coagulation biomarkers are associated with poor outcomes among people living with HIV (PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods From March 2014 to October 2014,...
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| Format: | Article |
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BMC
2020-07-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-020-05213-1 |
| _version_ | 1818059988854112256 |
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| author | Chloe A. Teasdale Cecilia Hernandez Allison Zerbe Duncan Chege Mark Hawken Wafaa M. El-Sadr |
| author_facet | Chloe A. Teasdale Cecilia Hernandez Allison Zerbe Duncan Chege Mark Hawken Wafaa M. El-Sadr |
| author_sort | Chloe A. Teasdale |
| collection | DOAJ |
| description | Abstract Background Increased coagulation biomarkers are associated with poor outcomes among people living with HIV (PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between HIV viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to 6 months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at 6 months is reported on the log10 scale and as percentage change from baseline. Results Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29–43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600-399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (> 500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7–926.6) (log baseline D-dimer: 2.7, IQR: 2.5–3.0). Higher baseline D-dimer was significantly associated with higher viral load (p < 0.0001), female sex (p = 0.02) and tuberculosis (p = 0.02). After 6 months on ART, 518 (84.8%) PLHIV had achieved viral load < 1000 copies/mL and median D-dimer was 390.0 (IQR: 236.6–656.9) (log D-dimer: 2.6, IQR: 2.4–2.8). Mean change in log D-dimer from baseline to 6 months was − 0.12 (95%CI −0.15, − 0.09) (p < 0.0001) indicating at 31.3% decline (95%CI −40.0, − 23.0) in D-dimer levels over the first 6 months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation (− 172.1, 95%CI −259.0, − 106.3; p < 0.0001) and those with log viral load > 6.0 copies/mL (− 91.1, 95%CI −136.7, − 54.2; p < 0.01). Conclusions In this large Kenyan cohort of PLHIV, women, those with tuberculosis and higher viral load had elevated baseline D-dimer. ART initiation and viral load suppression among ART-naïve PLHIV in Kenya were associated with significant decrease in D-dimer at 6 months in this large African cohort. |
| first_indexed | 2024-12-10T13:25:17Z |
| format | Article |
| id | doaj.art-2febefd7195c416793bb7000ae8c0fbf |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-10T13:25:17Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-2febefd7195c416793bb7000ae8c0fbf2022-12-22T01:47:11ZengBMCBMC Infectious Diseases1471-23342020-07-012011810.1186/s12879-020-05213-1Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in KenyaChloe A. Teasdale0Cecilia Hernandez1Allison Zerbe2Duncan Chege3Mark Hawken4Wafaa M. El-Sadr5Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health PolicyICAP at Columbia University, Mailman School of Public Health, Columbia UniversityICAP at Columbia University, Mailman School of Public Health, Columbia UniversityICAP at Columbia University, Mailman School of Public Health, Columbia UniversityICAP at Columbia University, Mailman School of Public Health, Columbia UniversityICAP at Columbia University, Mailman School of Public Health, Columbia UniversityAbstract Background Increased coagulation biomarkers are associated with poor outcomes among people living with HIV (PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between HIV viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to 6 months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at 6 months is reported on the log10 scale and as percentage change from baseline. Results Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29–43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600-399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (> 500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7–926.6) (log baseline D-dimer: 2.7, IQR: 2.5–3.0). Higher baseline D-dimer was significantly associated with higher viral load (p < 0.0001), female sex (p = 0.02) and tuberculosis (p = 0.02). After 6 months on ART, 518 (84.8%) PLHIV had achieved viral load < 1000 copies/mL and median D-dimer was 390.0 (IQR: 236.6–656.9) (log D-dimer: 2.6, IQR: 2.4–2.8). Mean change in log D-dimer from baseline to 6 months was − 0.12 (95%CI −0.15, − 0.09) (p < 0.0001) indicating at 31.3% decline (95%CI −40.0, − 23.0) in D-dimer levels over the first 6 months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation (− 172.1, 95%CI −259.0, − 106.3; p < 0.0001) and those with log viral load > 6.0 copies/mL (− 91.1, 95%CI −136.7, − 54.2; p < 0.01). Conclusions In this large Kenyan cohort of PLHIV, women, those with tuberculosis and higher viral load had elevated baseline D-dimer. ART initiation and viral load suppression among ART-naïve PLHIV in Kenya were associated with significant decrease in D-dimer at 6 months in this large African cohort.http://link.springer.com/article/10.1186/s12879-020-05213-1CoagulationD-dimerART initiationTuberculosisWomen |
| spellingShingle | Chloe A. Teasdale Cecilia Hernandez Allison Zerbe Duncan Chege Mark Hawken Wafaa M. El-Sadr Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya BMC Infectious Diseases Coagulation D-dimer ART initiation Tuberculosis Women |
| title | Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya |
| title_full | Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya |
| title_fullStr | Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya |
| title_full_unstemmed | Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya |
| title_short | Changes in D-dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya |
| title_sort | changes in d dimer after initiation of antiretroviral therapy in adults living with hiv in kenya |
| topic | Coagulation D-dimer ART initiation Tuberculosis Women |
| url | http://link.springer.com/article/10.1186/s12879-020-05213-1 |
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