Inflammatory Biomarkers Predicting Major Adverse Cardiovascular Events in People Living With HIV: A Systematic Review...

Area of Science:

• Cardiology
• Infectious Diseases
• Immunology

Background:

• Chronic inflammation is a key factor in cardiovascular disease (CVD) risk for people living with HIV.
• Current consensus on the predictive value of inflammatory biomarkers for CVD in this population is lacking.

Purpose of the Study:

• To systematically review the predictive value of inflammatory biomarkers for major adverse cardiovascular events (MACE) in people living with HIV.
• To inform the potential integration of these biomarkers into CVD risk assessment strategies.

Main Methods:

• A systematic search of MEDLINE, Embase, and Google Scholar was conducted up to May 1, 2024.
• Included studies were prospective cohorts or nested case-control studies of adults living with HIV with biomarker measurements and at least one year of follow-up for MACE.
• Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool, and meta-analysis was performed where appropriate.

Main Results:

• Twenty-one studies identified 31 inflammatory biomarkers. High-sensitivity C-reactive protein (hsCRP) was positively associated with future CVD events (HR=1.86 per log10 unit).
• Interleukin-6 (IL-6), D-dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP) showed significant associations in at least two studies, but meta-analysis was precluded by heterogeneity.
• Most studies were from high-income settings with low female representation, and a moderate to high risk of bias was common.

Conclusions:

• Several inflammatory biomarkers show potential for predicting CVD in people with HIV, supporting inflammation's role in HIV-related CVD.
• However, evidence is limited by study heterogeneity, methodological quality, and underrepresentation of women and low- and middle-income countries (LMICs).
• Larger, representative studies are needed to validate these biomarkers for clinical risk prediction models.