Abstract
Background: Human immunodeficiency virus infection has been proposed to inflict an insult on hemostatic system which involves endothelium, platelet and coagulation proteins. Information regarding hemostatic profile in human immunodeficiency virus infected patients is limited and contradicting too. Method: A case control study was conducted from April to May 2014 in Jimma University specialized hospital, involving 96 HIV infected patients and 96 healthy controls that came consecutively to comprehensive chronic care center and voluntary counseling and testing (VCT) center respectively. Socio demographic and clinical data were obtained using structured questionnaire. For the purpose of hemostasis tests, 2.7ml of venous blood sample was collected in a 3ml citrated (3.2%) vacuum tube. Platelet count and CD4 count was determined from a 3ml EDTA sample. Mixing study was undertaken for prolonged coagulation tests. Data were analyzed using SPSS, version 20. Result: The mean value of prothrombin time (PT), international normalized ratio(INR), activated partial thromboplastin time(APTT) and fibrinogen level was significantly higher in case group than control (p< 0.001, 0.01, <0.001 and <0.001) while mean platelet count was significantly lower in case group (p<0.0001). Mixing study showed correction of 35(87.5%) of 40 prolonged PT both in immediate and delayed test while 58(95.1%) of 60 prolonged activated APTT fail to correct in both situations. A CD4 count of less than 200cells/mm 3(AOR=8.8, 95% CI (1.8-42.4)) and HAART (AOR=3.4, 95%CI (1.2-10.1)) use were significantly associated with prolonged PT while a CD4 count of less than 200cells/mm3 (AOR=11.55, 95% CI (1.25-106)) was significantly associated with prolonged APTT. Conclusion: There was a significant mean difference between case and control groups with respect to PT, APTT, platelet count and fibrinogen level. Direction of the finding points towards presence of inhibitors and factor deficiency which demands in depth investigation and corresponding intervention.
Highlights
Studies are emerging that shows the interaction between coagulation and inflammation as a response to severe infection or trauma which results in a systemic activation of a coagulation system [1]
A large body of evidence suggest that there is hemostatic abnormality in HIV infected individuals, of which thrombocytopenia is widely spread and best documented [13,14], as well as prolonged APTT [15,16].This study showed significantly higher APTT (P=
Our finding appreciates the difference in hemostatic profiles of HIV-positive and negative individuals
Summary
Studies are emerging that shows the interaction between coagulation and inflammation as a response to severe infection or trauma which results in a systemic activation of a coagulation system [1]. Coagulation abnormalities that are described in HIV infection are acquired deficiency state of physiological anticoagulants: protein C [3], protein S [4] and heparin cofactor II [5] with deficiency of protein S being the most consistent observation [4]. Anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) have been reported in HIV-infected patients with a prevalence ranging from 7 to 94% and 0 to 72%, respectively [8]. Human immunodeficiency virus infection has been proposed to inflict an insult on hemostatic system which involves endothelium, platelet and coagulation proteins. Information regarding hemostatic profile in human immunodeficiency virus infected patients is limited and contradicting too
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