Borges, Álvaro H.O'Connor, Jemma L.Phillips, Andrew N.Baker, Jason V.Vjecha, Michael J.Losso, Marcelo H.Klinker, HartwigLopardo, GustavoWilliams, IanLundgren, Jens D.Gatell, José M.INSIGHT SMART Study GroupESPRIT Study GroupSILCAAT Scientific Committee2018-03-162018-03-162014-03-131932-6203https://hdl.handle.net/2445/120845BACKGROUND: 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.11 p.application/pdfengcc-by (c) Borges, Álvaro H. et al., 2014http://creativecommons.org/licenses/by/3.0/esInfeccions per VIHPersones seropositivesPlasma sanguiniFibrinòlisiHepatitisHIV infectionsHIV-positive personsBlood plasmaFibrinolysisHepatitisinfo:eu-repo/semantics/article6491532018-03-16info:eu-repo/semantics/openAccess24626096