The role of C-reactive protein as a marker for cardiovascular risk associated with antiretroviral therapy in HIV-infected patients

Abstract

C-reactive protein (CRP) has been associated with prognosis of HIV-infection, but its relationship with cardiovascular disease remains unknown. We aimed to evaluate whether CRP may be a marker of cardiovascular risk in HIV-infected patients, and to determine the influence of antiretroviral therapy (ART) on CRP levels. We conducted a cross-sectional study on 245 consecutive HIV-infected patients during a 2-month period. An extensive workup for cardiovascular risk was performed, including determination of CRP levels measured by an ultrasensitive immunoturbidimetric assay (detection limit, 0.003 mg/dl). Ninety-nine (40.4%) patients had serum CRP concentrations above 0.3 mg/dl, considered to represent individuals at high risk for developing cardiovascular complications. In univariate analysis, CRP levels correlated positively with total cholesterol (p=0.01), LDL cholesterol (p=0.001), triglycerides (p=0.04) and Framingham risk score (p=0.006), and negatively with HDL cholesterol (p=0.004). Concentrations of CRP were higher in males (p=0.05) and smokers (p=0.002). No correlation was found between CRP levels and HIV-viral load or CD4 cell counts. In multivariate analysis, independent factors associated with the highest quartile of serum CRP concentrations (0.49 mg/dl) were LDL-cholesterol (p<0.001), HDL-cholesterol (p=0.001), cigarette smoking (p=0.019) and current ART (p=0.021). Our results show that C-reactive protein is associated with traditional cardiovascular risk factors, and may then be a marker for cardiovascular risk linked to HIV infection and ART.