@article {5206,
	title = {D-Dimer Levels before HIV Seroconversion Remain Elevated Even after Viral Suppression and Are Associated with an Increased Risk of Non-AIDS Events.},
	journal = {PloS one},
	volume = {11},
	year = {2016},
	month = {2016},
	pages = {e0152588},
	abstract = {The mechanism underlying the excess risk of non-AIDS diseases among HIV infected people is unclear. HIV associated inflammation/hypercoagulability likely plays a role. While antiretroviral therapy (ART) may return this process to pre-HIV levels, this has not been directly demonstrated. We analyzed data/specimens on 249 HIV+ participants from the US Military HIV Natural History Study, a prospective, multicenter observational cohort of >5600 active duty military personnel and beneficiaries living with HIV. We used stored blood specimens to measure D-dimer and Interleukin-6 (IL-6) at three time points: pre-HIV seroconversion, >=6 months post-HIV seroconversion but prior to ART initiation, and >=6 months post-ART with documented HIV viral suppression on two successive evaluations. We evaluated the changes in biomarker levels between time points, and the association between these biomarker changes and future non-AIDS events. During a median follow-up of 3.7 years, there were 28 incident non-AIDS diseases. At ART initiation, the median CD4 count was 361cells/mm3; median duration of documented HIV infection 392 days; median time on ART was 354 days. Adjusted mean percent increase in D-dimer levels from pre-seroconversion to post-ART was 75.1\% (95\% confidence interval 24.6-148.0, p = 0.002). This increase in D-dimer was associated with a significant 22\% increase risk of future non-AIDS events (p = 0.03). Changes in IL-6 levels across time points were small and not associated with future non-AIDS events. In conclusion, ART initiation and HIV viral suppression does not eliminate HIV associated elevation in D-dimer levels. This residual pathology is associated with an increased risk of future non-AIDS diseases.},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0152588},
	author = {Freiberg, Matthew S and Bebu, Ionut and Tracy, Russell and So-Armah, Kaku and Okulicz, Jason and Ganesan, Anuradha and Armstrong, Adam and O{\textquoteright}Bryan, Thomas and Rimland, David and Justice, Amy C and Agan, Brian K}
}
