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Randomized Controlled Trial
. 2009 Sep 24;23(15):2015-9.
doi: 10.1097/QAD.0b013e32832d72c6.

Interleukin-2 cycling causes transient increases in high-sensitivity C-reactive protein and D-dimer that are not associated with plasma HIV-RNA levels

Brian O Porter  1 , Jean Shen, Joseph A Kovacs, Richard T Davey, Catherine Rehm, Jay Lozier, Gyorgy Csako, Khanh Nghiem, Rene Costello, Henry Clifford Lane, Irini Sereti
Affiliations
Randomized Controlled Trial

Interleukin-2 cycling causes transient increases in high-sensitivity C-reactive protein and D-dimer that are not associated with plasma HIV-RNA levels

Brian O Porter et al. AIDS. .

Abstract

Objective: To determine the effects of interleukin (IL)-2 treatment on inflammatory and thrombotic biomarkers in chronically HIV-infected adults receiving antiretroviral therapy.

Methods: Cryopreserved plasma was evaluated retrospectively for C-reactive protein (CRP) and D-dimer at baseline, end of an IL-2 cycle, and long-term follow up from two randomized, controlled trials: 57 IL-2-naive adults receiving either three to six cycles of IL-2 as well as antiretroviral therapy (nucleoside analogues) or antiretroviral therapy alone for 12 months, and 40 IL-2-experienced adults on highly active antiretroviral therapy who either interrupted or continued therapy for 6 months after a baseline IL-2 cycle. High-sensitivity CRP (hsCRP) was measured by immunonephelometry (detection limit 0.175 mg/l) and D-dimer by latex agglutination (detection limit 0.20 mg/l). Median within-group differences and pre and post-IL-2 changes between groups were assessed via nonparametric Wilcoxon signed-rank and Mann-Whitney U-tests. Spearman's rank test was used to assess correlations between changes in hsCRP, D-dimer, and HIV-RNA viral load.

Results: Significant increases in hsCRP (study 1: 138.6 mg/l; study 2: 58.9 mg/l) and D-dimer (study 1: 3.1 mg/l; study 2: 0.4 mg/l, all P < 0.0001) occurred by the end of the initial IL-2 cycle, returning to baseline by the end of study. No correlations were seen between changes in hsCRP or D-dimer and HIV-RNA, CD4 T-cell count, or proliferation (Ki67 expression). No thrombotic or cardiovascular serious adverse events occurred during these study periods.

Conclusion: IL-2 dosing caused transient increases in plasma hsCRP and D-dimer levels, regardless of HIV-RNA viral load, suggesting the possibility of increased risk for thrombotic events.

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Conflict of interest statement

Conflicts of Interest: The US Government has been granted a patent for the use of intermittent subcutaneous IL-2 as therapy in HIV infection, listing H. C. Lane and J.A. Kovacs as co-inventors.

Figures

Figure 1
Figure 1. IL-2-associated changes in biomarker levels
Significant increases were evident immediately following interleukin (IL)-2 cycling in plasma high-sensitivity C-reactive protein (hsCRP) and D-dimer levels in Study 1 (A and C) and Study 2 (B and D), which normalized by long-term follow-up, regardless of the presence of HAART and, hence, HIV viremia. HAART = highly active antiretroviral treatment; D = day, M = month; *p<0.0001
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