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Timing of Antiretroviral Therapy and Systemic Inflammation in Sub-Saharan Africa: Results From the META Longitudinal Cohort Study.

  • Author(s): Siedner, Mark J
  • Bwana, Mwebesa Bosco
  • Asiimwe, Stephen
  • Amanyire, Gideon
  • Musinguzi, Nicholas
  • Castillo-Mancilla, Jose
  • Tracy, Russell P
  • Katz, Ingrid T
  • Bangsberg, David R
  • Hunt, Peter W
  • Orrell, Catherine
  • Haberer, Jessica E
  • META study investigators
  • et al.

Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/µL) or late-stage disease (CD4 T-cell count <200/µL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in late-stage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.

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