1. Immunologic Pathways That Predict Mortality in HIV-Infected Ugandans Initiating Antiretroviral Therapy
- Author
-
Lee, Sulggi, Byakwaga, Helen, Boum, Yap, Burdo, Tricia H, Williams, Kenneth C, Lederman, Michael M, Huang, Yong, Tracy, Russell P, Cao, Huyen, Haberer, Jessica E, Kembabazi, Annet, Bangsberg, David R, Martin, Jeffrey N, and Hunt, Peter W
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Immunology ,Clinical Research ,HIV/AIDS ,Infectious Diseases ,Sexually Transmitted Infections ,Infection ,Good Health and Well Being ,Adult ,Anti-HIV Agents ,Biomarkers ,Cohort Studies ,Female ,Fibrin Fibrinogen Degradation Products ,HIV Infections ,Humans ,Interleukin-6 ,Kynurenine ,Lipopolysaccharide Receptors ,Male ,Multivariate Analysis ,Prognosis ,Proportional Hazards Models ,T-Lymphocytes ,Tryptophan ,Uganda ,Viral Load ,HIV ,kynurenine ,tryptophan ,D-dimer ,IL-6 ,sCD14 ,mortality ,antiretroviral therapy ,Africa ,Africa. ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Biological sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
The plasma kynurenine/tryptophan (KT) ratio, a marker of adaptive immune defects, strongly predicts mortality during treated human immunodeficiency virus (HIV) disease in Ugandans as compared to US-based populations. Here, the KT ratio and T-cell and plasma biomarkers of immune activation were measured among 535 HIV-infected Ugandans prior to ART initiation and at month 6 of viral suppression. The month 6 KT ratio (adjusted hazard ratio [aHR], 2.74), soluble CD14 level (aHR, 2.32), interleukin 6 level (aHR, 2.34), and D-dimer level (aHR, 1.95) were associated with mortality occurring ≥6 months after ART initiation. The KT ratio remained significantly predictive of mortality even after adjustment for the additional biomarkers, suggesting an independent contribution to clinical outcomes in resource-limited settings.
- Published
- 2017