Selected inflammatory and coagulation biomarkers pre-viral suppression in people with human immunodeficiency virus (HIV) infection without overt cardiovascular disease: Is there a need to redefine reference indices?

•Human immunodeficiency (HIV) infection is a significant cause of morbidity and mortality in Africa, despite antiretroviral therapy.•Opportunistic infections still occur but the significant contribution of non-communicable complications to the HIV disease burden is increasingly recognised with a prominence of cardiovascular disease (CVD).•Ongoing inflammation and immune activation with resultant elevation of biomarkers are prominent in people living with HIV (PLWH) and probably contribute to CVD manifestations.•Researchers have attempted to develop predictive CVD risk scores in PLWH by correlating the various biomarkers with both clinical presentation and other manifestations of arterial disease.•We conducted a systematic review to inform interpretation of 5 biomarkers commonly measured in PLWH namely interleukin-6 (IL-6), tumour necrosis factor (TNF-α), D-dimers, and soluble vascular cell and soluble intracellular adhesion molecules-1 (sVCAM-1 and sICAM-1) to attempt to define a range for these parameters in ART naïve PLWH without overt CVD. Human immunodeficiency virus (HIV) infection is prevalent in Africa and causes morbidity and mortality despite antiretroviral therapy (ART). Non-communicable complications of HIV infection include cardiovascular disease (CVD) with thromboses throughout the vascular tree. Ongoing inflammation and endothelial dysfunction in people living with HIV (PLWH) probably contribute significantly to HIV-related CVD. A systematic review was conducted to inform interpretation of 5 biomarkers commonly measured in PLWH namely interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), D-dimers, and soluble intracellular and vascular adhesion molecules-1 (sICAM-1 and sVCAM-1) to attempt to define a range for these values in ART naïve PLWH without overt CVD or additional comorbid diseases. A systematic search was conducted for all studies documenting the levels of the above biomarkers in ART naïve PLWH published on the PubMed database from 1994 to 2020. The number of publications that reported medians above the assay values was: 4/15 for D-dimer; 0/5 for TNF-α, 8/16 for IL-6, 3/6 for sVCAM-1, and 4/5 for sICAM-1. The clinical utility of biomarkers is reduced by the lack of standardisation of the measurement of these parameters, absence of normal reference indices and the lack of uniformity of study protocols in different research centres. This review supports the ongoing use of D-dimers to predict thrombotic and bleeding events in PLWH