d-Dimer and CRP levels are elevated prior to antiretroviral treatment in patients who develop IRIS

Biomarkers could be useful in evaluating immune reconstitution inflammatory syndrome (IRIS). A cohort of 45 HIV-1-infected, antiretroviral treatment (ART)-naive patients with baseline CD4 T cell counts ≤ 100 cells/μL who were started on ART, suppressed HIV-RNA to < 50 copies/mL, and seen every 1–3 months for 1 year were retrospectively evaluated for suspected or confirmed IRIS. d-Dimer, C-reactive protein (CRP), and selected autoantibodies were analyzed at baseline, 1 and 3 months post-ART in cryopreserved plasma. Median differences between cases and controls were compared with Mann–Whitney and Fisher's exact tests. Sixteen patients (35.6%) developed IRIS (median of 35 days post-ART initiation): unmasking = 8, paradoxical = 7, autoimmune = 1. Pre-ART d-dimer and CRP were higher in IRIS cases versus controls (d-dimer: 0.89 mg/L versus 0.66 mg /L, p = 0.037; CRP: 0.74 mg/L versus 0.39 mg/L, p = 0.022), while d-dimer was higher in unmasking cases at IRIS onset (2.04 mg/L versus 0.36 mg /L, p = 0.05). These biomarkers may be useful in identifying patients at risk for IRIS.