The incidence of arterial and venous thrombosis in HIV-infected patients is increased compared to healthy controls. In this cross-sectional analysis we measured markers of endothelial cell activation, thrombin generation, fibrinolysis and anticoagulation combined with endogenous thrombin potential (ETP) and activated protein C sensitivity ratio (APCsr) as more global markers. We included 160 consecutive HIV-infected patients with a median age of 46 years (range, 27-77), of whom 92% were male, 74% Caucasian, 11% African American, 9% Hispanic, and 6% Asian. Homosexual contact was the main transmission mode. Seventy percent of patients were using combined antiretroviral therapy (cART). In 83% of patients laboratory markers outside the normal range for a non-HIV-infected population were observed. Significant lower levels of von Willebrand factor (vWF; p = 0.03), factor VIII (p < 0.0001), D-dimer (p = 0.01), and ETP (p = 0.01) were observed in HIV-infected patients on cART compared to patients not on cART. Significant lower levels of protein C (p = 0.05) and free protein S (p < 0.0001), and increased APCsr (p < 0.0001) were found in the HIV-infected patients not on cART. A single association was observed between raised levels of fibrinogen and use of a protease inhibitor (p = 0.002). No significant difference was observed in the percentage of patients with laboratory markers outside the normal range between patients using cART-regimens containing abacavir, stavudine, or didanosine and those with other nucleoside reverse transcriptase inhibitors. Although the prevalence of coagulation abnormalities was lower in HIV-infected patients using cART, a considerable proportion of HIV-infected patients on cART show endothelial cell activation and increased APCsr, suggestive of a persistent procoagulant state.

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Keywords African American, Asian, Caucasian, Hispanic, Human immunodeficiency virus infected patient, Human immunodeficiency virus infection, RNA directed DNA polymerase inhibitor, abacavir, activated protein C, adult, aged, anticoagulation, antiretrovirus agent, article, atazanavir, blood clotting factor 8, cell activation, controlled study, cross-sectional study, didanosine, disease transmission, endothelium cell, female, fibrinogen, fibrinolysis, hemostasis, highly active antiretroviral therapy, homosexuality, human, lopinavir plus ritonavir, major clinical study, male, protein C, protein S, proteinase inhibitor, ritonavir, stavudine, thrombin, thrombin time, von Willebrand factor
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Journal AIDS Patient Care and STDs
Jong, E, Louw, S, Meijers, J.C.M, de Kruif, M.D, ten Cate, H, Büller, H.R, … van Gorp, E.C.M. (2009). The hemostatic balance in HIV-infected patients with and without antiretroviral therapy: Partial restoration with antiretroviral therapy. AIDS Patient Care and STDs, 23(12), 1001–1007. doi:10.1089/apc.2009.0173