{"id":21344,"date":"2013-05-29T14:48:21","date_gmt":"2013-05-29T14:48:21","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=21344"},"modified":"2013-06-24T05:38:18","modified_gmt":"2013-06-24T05:38:18","slug":"osteonecrosis-in-hiv-positive-patients-is-associated-with-increased-levels-of-crp-and-d-dimer-2","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/21344","title":{"rendered":"Osteonecrosis in HIV positive patients is associated with increased levels of CRP and D-dimer"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

A retrospective case control study of 43 HIV positive patients with MRI-confirmed osteonecrosis of the femoral head (n=26 symptomatic, n=17 asymptomatic) found they had significantly elevated levels of the biomarkers C-reactive protein (CRP) and D-dimer compared to a control group of 50 HIV positive patients with negative MRI results.<\/strong><\/p>\n

This was a US study by Caryn Morse and colleagues from the National Institute of Health Clinical Centre and results were published as a concise communication in the 20 February 2013 edition of AIDS. [1]<\/p>\n

All participants were already enrolled in other NIH studies, including a natural history study of osteonecrosis,<\/p>\n

CRP (an inflammation marker commonly associated with cardiovascular disease) and D-dimer (a coagulation degradation product) have both been associated with increased risk of mortality and serious complications in HIV positive studies, independently of CD4 and viral load.<\/p>\n

Samples were used from osteonecroisis diagnosis (+\/- 2 months) and from at least 6 months prior to and post diagnosis for the active group, with the control using samples from the time of negative MRI and 6 months later. Values below the detection limit of the test were assigned a value of 0.21 mg\/mL for D-dimer and of 0.16 mg\/L for CRP.<\/p>\n

Although baseline characteristics (at time of MRI) was similar for both groups, significant differences included longer duration of HIV infection (median 11.7 (range 1.6\u201319.5) vs 8.8 (0.4\u201316.4) years, p=0.003) and lower CD4 count (median 465 (range 12\u20131117) vs 686 (71\u20131705) cells\/mm3, p=0.008) for the active vs control group respectively. Most participants were male (~90%) and on ART (~90%) with only 50% in each group having viral load <50 copies\/mL. A high percentage of both groups had prior use of IL-2 (40% vs 60%, respectively).<\/p>\n

Median levels of both D-dimer (0.32 vs 0.22 mg\/mL; p=0.016) and CRP (2.52 vs 1.23 mg\/L; p=0.003) were significantly higher in the active vs control group and remained significant after adjustment for viral load and anticardiolipin antibody status.<\/p>\n

However, in linear regression analysis, the patterns of elevations were different for each biomarker after adjusting for viral load. D-dimer increased from the prediagnosis to diagnosis time point only in the osteonecrosis group (from 0.2 ug\/L to 0.4 ug\/L vs 0.2 ug\/mL in controls). CRP levels remained stable (slope = zero) in each group over time. No difference was seen in D-dimer or CRP levels between the asymptomatic and symptomatic patients in the osteonecrosis group.<\/p>\n

In the discussion section of the paper, the authors noted that elevations in D-dimer are associated with the development of osteonecrosis, but that CRP elevation predate the development of osteonecrosis, suggesting that at-risk patients have persistently higher levels of chronic inflammation; and that both markers could potentially help identify patients at higher risk of osteonecrosis.<\/p>\n

Reference:<\/p>\n

Morse CG et al. Elevations in D-dimer and C-reactive protein are associated with the development of osteonecrosis of the hip in HIV-infected adults. AIDS 27(4):591\u2013595. 20 February 2013. doi: 10.1097\/QAD.0b013e32835c206a.
\nhttp:\/\/journals.lww.com\/aidsonline\/Abstract\/2013\/02200\/Elevations_in_D_dimer_and_C_reactive_protein_are.11.aspx<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Simon Collins, HIV i-Base A retrospective case control study of 43 HIV positive patients with MRI-confirmed osteonecrosis of the femoral head (n=26 symptomatic, n=17 asymptomatic) found they had significantly elevated levels of the biomarkers C-reactive protein (CRP) and D-dimer compared …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-21344","post","type-post","status-publish","format-standard","hentry","category-side-effects"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/21344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=21344"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/21344\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=21344"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=21344"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=21344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}