Change in high-sensitivity c-reactive protein levels following initiation of efavirenz-based antiretroviral regimens in HIV-infected individuals

Abstract

Elevations in C-reactive protein (CRP) are associated with increased cardiovascular disease (CVD) risk, increased HIV disease progression, and death in HIV-infected patients. Use of abacavir has been reported to increase CVD risk. We assessed the effect of virologically suppressive efavirenz (EFV)-based antiretroviral therapy on high sensitivity CRP (hsCRP) levels over a 96-week period with particular attention to the effect of gender and abacavir use. Banked sera from entry and week 96 visits of AIDS Clinical Trials Group A5095 participants were assayed for hsCRP, then analyzed by gender, abacavir randomization, and for correlation with changes in fasting metabolic parameters. Analyses of hsCRP were conducted in two phases and involved a total of 145 men and 51 women. hsCRP did not differ by gender at baseline but higher levels were seen at week 96 in women (median 6 mg/liter; Q1, Q3, 1.8, 13.8) compared to men (median 1.6 mg/liter; Q1, Q3, 0.9, 4.2, p < 0.001), with an estimated shift in hsCRP by gender of 2.5 mg/liter (95% CI 1.0, 5.1). There was no difference in hsCRP levels by abacavir use. Changes in hsCRP did not correlate with changes in insulin resistance or with changes in fasting lipids. Durably virologically suppressive therapy with EFV-based regimens did not decrease hsCRP levels over a 96-week period. hsCRP levels increased significantly only in women. Randomization to abacavir had no effect on changes in hsCRP levels. Changes in hsCRP levels did not correlate with changes in fasting metabolic parameters.

Figures

FIG. 1.

Flow diagram of cohort selection.

FIG. 2.

Week 0 and week 96 hsCRP by gender. (A) Distribution by hsCRP (mg/liter) values. Black bars represent median values. (B) Distribution by American Heart Association Risk categories. From bottom to top: hsCRP <1 mg/liter (low risk), 1–3 mg/liter (average risk), >3–10 mg/liter (high risk), and >10 mg/liter (outlier).

FIG. 3.

Week 0 and Week 96 hsCRP by treatment groups. (A) Distribution by hsCRP (mg/liter) values. Black bars represent median values. (B) Distribution by American Heart Association Risk categories. From bottom to top: hsCRP <1 mg/liter (low risk), 1–3 mg/liter (average risk), >3–10 mg/liter (high risk), and >10 mg/liter (outlier).