The effect of initiating combined antiretroviral therapy on endothelial cell activation and coagulation markers in South African HIV-infected individuals

Eefje Jong; Susan Louw; Eric C. M. van Gorp; Joost C. M. Meijers; Hugo ten Cate; Barry F. Jacobson

doi:10.1160/TH10-04-0233

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(06): 1228-1234
DOI: 10.1160/TH10-04-0233

Wound Healing and Inflammation / Infection

Schattauer GmbH

The effect of initiating combined antiretroviral therapy on endothelial cell activation and coagulation markers in South African HIV-infected individuals

Eefje Jong^*

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

²Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands

,

Susan Louw^*

³Department of Molecular Medicine and Haematology, Charlotte Maxeke Hospital, Johannesburg, South Africa

,

Eric C. M. van Gorp

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

⁴Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands

,

Joost C. M. Meijers

⁵Department of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

⁶Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Hugo ten Cate

⁷Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, University Hospital Maastricht and Cardiovascular Research Institute, Maastricht, the Netherlands

,

Barry F. Jacobson

³Department of Molecular Medicine and Haematology, Charlotte Maxeke Hospital, Johannesburg, South Africa

› Author Affiliations

Abstract

Summary

An increased incidence of venous thromboembolism (VTE) is observed in human immunodeficiency virus (HIV)-infected patients. Only a limited number of studies described the effect of combined antiretroviral therapy (cART) on coagulation markers. In a prospective cohort study in cART-naive South African HIV-infected individuals the effect of initiating cART on markers of endothelial cell activation, coagulation and natural anticoagulation was studied. These markers were compared to the reference ranges for an HIV-uninfected control population recruited from hospital staff. A venous ultrasound of both legs was performed to detect asymptomatic deep venous thrombosis (DVT). A total number of 123 HIV-infected participants were included. The patients were predominantly black and severely immuno-compromised. The CD4 cell count increased and the HIV viral load decreased significantly after the initiation of cART (p<0.001). The median follow-up period was 7.2 (± 1.6) months. Laboratory testing before and after initiation of cART was completed by 86 patients. Before initiating cART significantly elevated von Willebrand factor and D-dimer levels, increased activated protein C sensitivity ratio (APCsr) and decreased total and free protein S and protein C levels were observed compared to HIV-negative controls. At follow-up all markers, except APCsr, improved towards the normal range for controls without showing complete normalisation. In a subgroup of 57 patients no asymptomatic DVT was found. Compared to the controls, abnormal levels of coagulation markers were observed in HIV-infected individuals before and after the initiation of cART. Most markers improved after starting cART, but remained significantly different from the controls, indicating a persistent disturbed haemostatic balance.

Keywords

Coagulation factors - viral infection - venous thrombosis - clinical studies

Full Text

References

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