Top 10 HIV Clinical Developments of 2008 - CD8 T cells - The Body

16 • HIV JournalView—Top 10 HIV Clinical Developments of 2008
Study Snapshot: Inflammatory and Coagulation Biomarkers and Mortality in
INSIGHT SMART Study Groups
Design: A pair of investigations were conducted: (1) a nested case-control study of HIV-infected INSIGHT SMART participants
for studying biomarker associations with mortality, and (2) a study to compare drug conservation versus viral suppression
participants for biomarker changes.
Population: (1) 85 participants who died (55 were in the discontinuation of HIV therapy arm, the remainder in the continuation
arm) compared to two controls who did not die per each case. (2) About 250 participants without known prior CVD.
Main Results: The combined results show that, at baseline, the levels of almost all markers were higher in patients who died
(cases) than in the controls. IL-6 and D-dimer stood out as most significantly different between patients who died and those
who did not. Based on models of mortality risk generated from the baseline biomarker data, the differences in the change in
levels in the study arms are predicted to lead to a 16% to 24% increased risk of death for those stopping antiretroviral therapy.
Significance: Both investigations pin an attractively reasonable causative mechanism to the potentially catastrophic effects of
treatment cessation. Point to a new way to view the threats to the well-being of patients who, despite robust immune function,
have suboptimally controlled HIV infection. Irrevocably establish endothelial dysfunction as a dimension of the management of
HIV disease.