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*
1   Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
2   Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
,
Susan Louw*
3   Department of Molecular Medicine and Haematology, Charlotte Maxeke Hospital, Johannesburg, South Africa
,
Eric C. M. van Gorp
1   Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
4   Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands
,
Joost C. M. Meijers
5   Department of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
6   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Hugo ten Cate
7   Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, University Hospital Maastricht and Cardiovascular Research Institute, Maastricht, the Netherlands
,
Barry F. Jacobson
3   Department of Molecular Medicine and Haematology, Charlotte Maxeke Hospital, Johannesburg, South Africa
› Author Affiliations
Further Information

Publication History

Received: 14 April 2010

Accepted after major revision: 27 August 2010

Publication Date:
24 November 2017 (online)

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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.

* Both authors contributed equally to the manuscript.