1653. Racial Comparison of D-dimer Levels in Adults Before and After HIV Infection
Session: Poster Abstract Session: HIV: Cardiovascular Disease in HIV
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek 2015 poster.pdf (239.8 kB)
  • Background:

    D-dimer levels predict mortality in persons with HIV infection, including those with viral suppression.  Black race, older age, and comorbidities are associated with higher D-dimer levels in persons with and without HIV infection.  Mechanisms leading to higher D-dimer related to HIV are poorly understood.  We examined the effects of race and HIV by comparing changes in D-dimer levels among young adult African-Americans (AA) and Caucasians (C) before and after HIV infection.

    Methods:

    We analyzed clinical and laboratory data for 207 participants in the US Military HIV Natural History Study, a cohort of US military personnel and beneficiaries living with HIV.  Frozen stored sera were available at three time points (TP): TP1) pre-HIV seroconversion (SC), prior to last negative HIV test, TP2) >6 months post-HIV SC but prior to ART initiation, and TP3) >6 months post-ART with viral suppression on two successive evaluations.  At each TP, we used a D-dimer assay validated for serum.  No subject had known acute or chronic illness.  Continuous variables were analyzed using Mann-Whitney U test and are expressed as median (IQR).

    Results:

    Subjects included 94 AA and 113 C.  98% were male.  AA were younger (median age [yrs] of 25 vs 28, p=0.02 at TP1; 30 vs 31, p=0.007 at TP2; and 31 vs 33, p=0.009 at TP3).  Compared to C, AA D-dimer levels were similar at pre-HIV TP1 but were markedly higher at TP2 despite similar CD4 counts and HIV viral load (VL)(Table).  AA and C did not differ in D-dimer levels at TP3, median time (mos) from estimated SC to ART initiation (24 [13, 47] vs 27 [16, 51], p=0.13), or time (mos) from ART to TP3 (11 [8, 14] vs 12 [10, 14], p=0.46).

     

    AA

    C

    p-value

    D-Dimer  (ug/ml)

     

     

     

         TP1

    0.18 (0.08, 0.39)

    0.16 (0.08, 0.29)

    0.28

         TP2

    0.60 (0.29, 1.04)

    0.36 (0.21, 0.84)

    0.003

         TP3

    0.24 (0.16, 0.44)

    0.24 (0.16, 0.39)

    0.71

    CD4 cells/ul

     

     

     

         TP2

    339 (277, 449)

    367 (294, 443)

    0.62

         TP3

    549 (428, 778)

    531 (435, 689)

    0.55

    Log10 HIV VL

     

     

     

         TP2

    4.51 (3.95, 4.87)

    4.54 (3.95, 4.97)

    0.52

         TP3

    <1.70

    <1.70

     

    Conclusion:

    Among young military members over the course from pre-HIV to post- ART, AA had a more pronounced rise in D-dimer post-SC but their pre-HIV and post-ART levels were similar to C.  These data suggest racial differences in D-dimer may not be apparent in healthy young adults or persons with suppressed HIV and no comorbidities.

    Thomas O'bryan, MD1,2,3, Matthew Freiberg, MD, MSc4, Russell Tracy, PhD5, Kaku So-Armah, PhD6, Jason Okulicz, MD, FIDSA2, Anuradha Ganesan, MD, MPH1,3,7, Tahaniyat Lalani, MD1,3,8, Adam Armstrong, D.O.9, David Rimland, MD, FIDSA10, Robert Deiss, MD1,3,11 and Brian Agan, MD, FIDSA1,3, (1)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (2)San Antonio Military Medical Center, Fort Sam Houston, TX, (3)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (4)Division of Cardiovascular Medicine, Vanderbuilt University, Nashville, TN, (5)Department of Pathology, University of Vermont College of Medicine, Burlington, VT, (6)School of Public Health, Boston University, Boston, MA, (7)Walter Reed National Military Medical Center, Bethesda, MD, (8)Naval Medical Center Portsmouth, Portsmouth, VA, (9)U.S. Naval Medical Research Unit, Lima, Peru, (10)Atlanta VA Medical Center, Decatur, GA, (11)Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA

    Disclosures:

    T. O'bryan, None

    M. Freiberg, None

    R. Tracy, None

    K. So-Armah, None

    J. Okulicz, None

    A. Ganesan, None

    T. Lalani, None

    A. Armstrong, None

    D. Rimland, None

    R. Deiss, None

    B. Agan, None

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