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Markers of Inflammation, Blood-Clotting Tied to Hazards of Intermittent HIV Treatment BETHESDA, Md -- October 21, 2008 -- Higher levels of certain markers of inflammation and blood-clotting are strongly associated with intermittent antiretroviral treatment (ART) and with a higher risk of death from non-AIDS diseases, according to a study published in PLoS Medicine. The study was a further analysis of the Strategies for Management of Antiretroviral Therapy (SMART) study which compared the standard practice of continuous ART to suppress HIV in infected individuals with episodic ART based on CD4+ T-cell counts. The goal was to determine whether reducing exposure to antiretroviral drugs, which may have toxic side effects and can engender drug resistance, would be equally or more beneficial than suppressing HIV continuously. Unexpectedly, those who received episodic ART were more than twice as likely to develop disease or die, and the study ended early in 2006 as a result. Reflecting on this outcome, James D. Neaton, PhD, University of Minnesota, Minneapolis, Minnesota, and his colleagues hypothesised that pausing ART and allowing HIV levels to rise stimulated inflammation and blood clotting in some patients. To test their hypothesis, the scientists examined blood samples from the SMART trial for proteins that are biological markers of inflammation and blood clotting. They found that people who began the study with relatively higher levels of the biomarkers interleukin-6 (IL-6) and D-dimer were at greater risk of death than other study participants. They also found that IL-6 and D-dimer levels rose significantly in the intermittent-treatment group compared with the continuous treatment group after just 1 month of study. Based on these observations, the authors conclude that HIV-infected patients who have relatively high levels of IL-6 and D-dimer are at greater risk of death. Most of the deaths in SMART were attributed to non-AIDS-related diseases, the authors wrote, and giving intermittent ART to volunteers who began that study with elevated levels of these biomarkers may have further increased their risk of death. SOURCE: National Institutes of Health/National Institute of Allergy and Infectious Diseases E-mail this page to a friend or colleague! To print, use this version