Purpose of review
It is unknown whether biomarkers simply correlate with or are causal for HIV-associated outcomes. Mendelian randomization (MR), is a genetic epidemiologic approach used to disentangle causation from association. Here, we discuss the potential use of MR for differentiating whether biomarkers are correlating with or causal for HIV-associated outcomes.
Recent findings
MR refers to the random allocation of alleles at the time of gamete formation. In observational epidemiology, this refers to the use of genetic variants to estimate a causal effect between a modifiable risk factor and an outcome of interest. A formal MR study using a genetic marker as a proxy for the biomarker has not been conducted in the HIV field. However, in the post-genomic era this approach is being used increasingly. Examples are evidence for the causal role of body mass index on blood pressure and non-causal role of CRP in coronary heart disease. We discuss the conceptual framework, uses and limitations of MR in the context of HIV infection as well as specific biomarkers (IL-6, CRP) and genetic determinants (e.g., in CCR5, chemokine, and DARC genes) that associate with HIV-related outcomes.
Summary
Making the distinction between correlation and causality has particular relevance when a biomarker (e.g. IL-6) is potentially modifiable, in which case a biomarker-guided targeted treatment strategy may be feasible. Although the tenets of MR rest on strong assumptions, and conducting an MR study in HIV infection presents many challenges, it may offer the potential to identify causal biomarkers for HIV-associated outcomes.