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hsCRP Levels and CVD Risk Factors in Patients on ART

In a cohort of patients with virologic suppression and low estimated cardiovascular risk, hsCRP levels were elevated and were associated with increased BMI and lipid abnormalities.

Chronic immune activation and inflammation are believed to contribute to the increased cardiovascular risk often seen among HIV-infected individuals. Markers for chronic inflammation that are linked to cardiovascular risk, such as high-sensitivity C-reactive protein (hsCRP), are therefore of great interest. In this prospective cohort study, researchers assessed whether hsCRP levels were associated with various metabolic parameters in HIV-infected patients receiving potent combination antiretroviral therapy (ART).

Ninety-four patients were included in the study (median age, 44; 73% men; 57% white). The median nadir CD4 count was 190 cells/mm³, and the median duration of ART at enrollment was 790 days. About one third of patients had some level of lipoatrophy, and about half the patients were taking PI-based regimens. Median baseline values were as follows: CD4 count, 502 cells/mm³; viral load, 50 copies/mL; Framingham risk score, 3.0; and hsCRP level, 2.94 mg/L. Median follow-up was 7.7 months, with study visits taking place about every 4 months.

A multivariate analysis — with adjustment for age, sex, current CD4-cell count, current viral load, smoking status, fasting state, PI use, and use of lipid-lowering therapy — revealed that increased hsCRP levels were significantly associated with increased BMI, reduced levels of HDL cholesterol, and increased levels of non-HDL cholesterol and triglycerides.

Comment: Although this study was small and had fairly limited follow-up, researchers were able to identify associations between increased hsCRP levels, increased BMI values, and lipid abnormalities. Whether increased hsCRP levels have clinical implications in HIV-infected persons remains unknown. Much larger studies of hsCRP levels have been conducted in the general population, and yet uncertainty remains, even there, about the role of this biomarker in identifying and managing cardiovascular disease.

— Keith Henry, MD

Published in Journal Watch HIV/AIDS Clinical Care November 16, 2009

Citation(s):

Boger MS et al. Highly sensitive C-reactive protein, body mass index, and serum lipids in HIV-infected persons receiving antiretroviral therapy: A longitudinal study. J Acquir Immune Defic Syndr 2009 Dec; 52:480.

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