Immunologic Pathways That Predict Mortality in HIV-Infected Ugandans Initiating Antiretroviral Therapy
Journal of Infectious Disesases
The plasma kynurenine/tryptophan (KT) ratio, a marker of adaptive immune defects, strongly predicts mortality during treated human immunodeficiency virus (HIV) disease in Ugandans as compared to US-based populations. Here, the KT ratio and T-cell and plasma biomarkers of immune activation were measured among 535 HIV-infected Ugandans prior to ART initiation and at month 6 of viral suppression. The month 6 KT ratio (adjusted hazard ratio [aHR], 2.74), soluble CD14 level (aHR, 2.32), interleukin 6 level (aHR, 2.34), and D-dimer level (aHR, 1.95) were associated with mortality occurring ≥6 months after ART initiation. The KT ratio remained significantly predictive of mortality even after adjustment for the additional biomarkers, suggesting an independent contribution to clinical outcomes in resource-limited settings.
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Sulggi Lee, Helen Byakwaga, Yap Boum, Tricia H. Burdo, Kenneth C. Williams, Michael M. Lederman, Yong Huang, Russell P. Tracy, Huyen Cao, Jessica E. Haberer, Annet Kembabazi, David R. Bangsberg, Jeffrey N. Martin, Peter W. Hunt; Immunologic Pathways That Predict Mortality in HIV-Infected Ugandans Initiating Antiretroviral Therapy, The Journal of Infectious Diseases, Volume 215, Issue 8, 15 April 2017, Pages 1270–1274