Antiphospholipid antibodies in black south africans with hiv and acute coronary syndromes: prevalence and clinical correlates

Anthony C Becker,Sham Singh,Simon Stewart,Mohammed R Essop,Elena Libhaber,Karen Sliwa,Mohammed Tikly

doi:10.1186/1756-0500-4-379

Abstract

BackgroundHIV infection is associated with a high prevalence of antiphospholipid antibodies (aPL) and increased thrombotic events but the aetiopathogenic link between the two is unclear.FindingsProspective single centre study from Soweto, South Africa, comparing the prevalence of aPL in highly active anti-retroviral therapy (HAART) naïve HIV positive and negative patients presenting with Acute Coronary Syndromes (ACS). Between March 2004 and February 2008, 30 consecutive black South African HIV patients with ACS were compared to 30 black HIV negative patients with ACS. The HIV patients were younger (43 ± 7 vs. 54 ± 13, p = 0.004) and besides smoking (73% vs. 33%, p = 0.002) and lower HDL levels (0.8 ± 0.3 vs. 1.1 ± 0.4, p = 0.001) had fewer risk factors than the control group. HIV patients had a higher prevalence of anticardiolipin (aCL) IgG (47% vs. 10%, p = 0.003) and anti-prothrombin (aPT) IgG antibodies (87% vs. 21%, p < 0.001) but there was no difference in the prevalence of the antiphospholipid syndrome (44% vs. 24%, p = N/S) and aPL were not predictive of clinical or angiographic outcomes.ConclusionsTreatment naïve black South African HIV patients with ACS are younger with fewer traditional coronary risk factors than HIV negative patients but have a higher prevalence and different expression of aPL which is likely to be an epiphenomenon of the HIV infection rather than causally linked to thrombosis and the pathogenesis of ACS.

Highlights

HIV infection is known to be associated with an increased prevalence of aPL but the link to the antiphospholipid syndrome (APS) with clinical thrombosis including myocardial infarction (MI) is tenuous [1]
We have shown that treatment-naïve HIV positive black South African patients presenting with acute coronary syndromes (ACS) are younger with fewer traditional risk factors compared to HIV negative patients and have less atherosclerotic burden but higher thrombotic burden on angiography [6]
Treatment-naïve HIV patients presenting with ACS have different risk factors and clinical features compared to the HIV negative population as well as a higher prevalence and different pattern of aPL expression

Summary

Introduction

HIV infection is known to be associated with an increased prevalence of aPL but the link to the antiphospholipid syndrome (APS) with clinical thrombosis including myocardial infarction (MI) is tenuous [1]. Very few data exist on the prevalence of aPL in black patients especially aPT and IgA aPL isotypes in the setting of infections including HIV [3]. A prevalence of 43% (mainly IgG) aPT was found showing that the pattern of aPL in black South Africans differs from that found in caucasians [3]. We have shown that treatment-naïve HIV positive black South African patients presenting with acute coronary syndromes (ACS) are younger with fewer traditional risk factors compared to HIV negative patients and have less atherosclerotic burden but higher thrombotic burden on angiography [6]. HIV infection is associated with a high prevalence of antiphospholipid antibodies (aPL) and increased thrombotic events but the aetiopathogenic link between the two is unclear

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