NYMC Faculty Publications

Association of Markers of Hemostasis With Death in HIV-Infected Women

Author Type(s)

Faculty

DOI

10.1097/QAI.0000000000000306

Journal Title

Journal of Acquired Immune Deficiency Syndromes

First Page

287

Last Page

294

Document Type

Article

Publication Date

11-1-2014

Department

Medicine

Keywords

Adult, Biomarkers, Factor VIII, Female, Fibrin Fibrinogen Degradation Products, HIV Infections, Hemostasis, Humans, Middle Aged, Multivariate Analysis, Plasminogen Activator Inhibitor 1, Predictive Value of Tests, Prospective Studies, Protein S, United States

Disciplines

Medicine and Health Sciences

Abstract

: In HIV negatives, markers of hemostasis, including D-dimer, factor VIII, plasminogen activator inhibitor-1 antigen (PAI-1), and total protein S are associated with all-cause and cardiovascular disease mortality. In HIV positives, studies of D-dimer and factor VIII with death were limited to short follow-up; associations of PAI-1 and total protein S with death have not been examined. In 674 HIV-infected women from the Women's Interagency HIV Study, markers from the first visit after enrollment were exposures of interest in multivariate analyses of death (AIDS and non-AIDS) in separate models at 5 and 16 years. There were 87 AIDS and 44 non-AIDS deaths at 5 years, and 159 AIDS and 113 non-AIDS deaths at 16 years. An inverse association of total protein S quartiles with non-AIDS deaths was observed at 5 (P trend = 0.002) and 16 years (P trend = 0.02); there was no association with AIDS deaths. The third quartile of PAI-1 was associated with AIDS deaths at 5 [hazard ratio (HR) = 4.0; 95% confidence interval (CI): 1.9 to 8.4] and 16 years (HR = 3.4; 95% CI: 1.9 to 5.9); and with non-AIDS deaths at 5 years (HR = 4.8; 95% CI: 1.6 to 13.9). D-dimer and factor VIII were not associated with AIDS or non-AIDS death at 5 or 16 years. Lower total Protein S was a consistent marker of non-AIDS death. We found no association between D-dimer with AIDS or non-AIDS death, in contrast to previous studies showing increased short-term (< 5 years) mortality, which may represent sex differences or population heterogeneity. Given longer survival on highly active antiretroviral therapy, further studies of these markers are needed to determine their prognostic value.

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