2158. Relationship of Albumin/Globulin Ratio with Biomarkers of Inflammation and Coagulation in HIV-Infected Persons Before and After Combination Antiretroviral Therapy
Session: Poster Abstract Session: HIV Inflammation and Immune Activation
Saturday, October 29, 2016
Room: Poster Hall
  • IDWeek_2016_poster_AG_relationships_O'Bryan.pdf (427.7 kB)


    Albumin/Globulin ratio (AG) typically declines in HIV infection due to excess immunoglobulin production by hyperactive B-cells and improves with antiretroviral therapy (ART) but may not fully reverse. The significance of AG in earlier stages of HIV disease is unclear. We compared AG with levels of interleukin-6 (IL-6) and D-dimer, biomarkers associated with mortality in HIV infection, before and after ART initiation among participants in the U.S. Military HIV Natural History Study (NHS).


    194 persons in the NHS, a cohort of US military personnel and beneficiaries living with HIV, were retrospectively studied.  Frozen stored sera were used to measure levels of IL-6 and D-dimer with assays validated for serum at two time points:  ≥6 months post-HIV seroconversion but prior to ART initiation, and ≥6 months post-ART with viral suppression (< 50 copies/ml) on two successive evaluations.  Laboratory values were analyzed using Spearman’s rank correlation and Mann-Whitney U test.


    Participants were 45% Caucasian, 38% African-American and 98% male.  Mean (SD) age was 31 (7) yrs. at the pre-ART time point. Median (IQR) time from seroconversion to ART start was 23 (14, 44) mos. and time from ART initiation to post-ART time point was 12 (9, 14) mos. Data are shown below as median (IQR):






    1.23 (1.07, 1.43)

    1.45 (1.29, 1.65)


    Albumin (g/dl)

    4.3 (4.1, 4.5)

    4.4 (4.2,4.7)


    Globulin (g/dl)

    3.5 (3.1, 4.0)

    3.1 (2.8, 3.4)


    D-dimer (ug/ml)

    0.44 (0.23, 0.97)

    0.24 (0.16, 0.43)


    IL-6 (pg/ml)

    1.82 (1.27, 3.08)

    1.75 (1.08, 3.16)


    ESR (mm/h)

    10 (6, 15)

    6 (3, 10)


    CD4 cells/ul

    357 (284, 451)

    537 (434, 700)


    CD4/CD8 ratio

    0.44 (0.32, 0.61)

    0.78 (0.57, 1.01)


    Pre-ART, AG inversely correlated with D-dimer (r=-.34, p<0.001), IL-6 (r=-.16, p=0.029), ESR (r=-.47, p<0.001), positively correlated with CD4/CD8 ratio (r=.26, p<0.001) and did not correlate with viral load or CD4 count. Post-ART, AG inversely correlated with IL-6 (r=-.22, p=0.002) and ESR (r=-.42, p<0.001), but did not correlate with D-dimer, CD4 count or CD4/CD8 ratio.


    These data suggest AG is reflective of pathways of inflammation and coagulation pre-ART. Persistent B-cell activation may contribute to residual inflammation post-ART.



    Thomas O'bryan, MD1,2,3, Matthew Freiberg, MD, MSc4, Russell Tracy, PhD5, Jason Okulicz, MD1,2, Tahaniyat Lalani, MD1,3,6, Anuradha Ganesan, MD, MPH7,8,9, Robert Deiss, MD1,3,10 and Brian Agan, MD1,3, (1)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (2)San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, TX, (3)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (4)Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, (5)Department of Pathology, University of Vermont College of Medicine, Burlington, VT, (6)Naval Medical Center Portsmouth, Portsmouth, VA, (7)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (8)Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (9)Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD, (10)Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA


    T. O'bryan, None

    M. Freiberg, None

    R. Tracy, None

    J. Okulicz, None

    T. Lalani, None

    A. Ganesan, None

    R. Deiss, None

    B. Agan, None

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