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

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH10-04-0233
Issue: 2010: 104/6 (Dec) pp. 1083-1289
Pages: 1228-1234

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

E. Jong (1, 2), S. Louw (3), E. C. M. van Gorp (1, 4), J. C. M. Meijers (5, 6), H. ten Cate (7), B. F. Jacobson (3)

(1) Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands; (2) Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands; (3) Department of Molecular Medicine and Haematology, Charlotte Maxeke Hospital, Johannesburg, South Africa; (4) Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands; (5) Department of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands; (6) Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands; (7) Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, University Hospital Maastricht and Cardiovascular Research Institute, Maastricht, the Netherlands

Keywords

Venous thrombosis, Viral infection, clinical studies, Coagulation factors

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.

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