Abstract
BackgroundAntiretroviral therapy (ART) alters platelet reactivity, and as a consequence, patients living with HIV may be at an increased risk of cardiovascular disease (CVD). The current evidence on platelet activation levels in patients with HIV remains inconclusive. We therefore aimed to systematically synthesise evidence on the association of platelet activation in HIV-infected patients on successful treatment.MethodsElectronic databases were searched from inception until November 2019. Studies were included if the primary or secondary outcome of the study was to assess platelet activation in HIV-infected patients on ART. The primary outcome of this review included the levels of platelet activation. The pooled effect estimates were calculated using a random-effects meta-analysis model.ResultsWe identified 30 studies comprising of 2325 participants. The pooled estimates showed elevated levels of platelet activation in treatment-naïve HIV-infected patients compared to uninfected controls (Hedges’ g 2.00 [95%CI 1.05, 2.94]; z = 4.12, p < 0.0001). These remained elevated despite successful ART (Hedges’ g 2.05 [95%CI 0.58, 3.52]; z = 2.71, p = 0.0067).ConclusionThe levels of platelet activation are elevated in treatment-naïve HIV-infected patients, and these persist during successful ART. Further studies should assess the clinical relevance of monitoring the levels of platelet activation in HIV-infected patients on ART.
Highlights
Antiretroviral therapy (ART) alters platelet reactivity, and as a consequence, patients living with HIV may be at an increased risk of cardiovascular disease (CVD)
Incongruent findings on the levels of platelets activation in people living with HIV (PLWHIV) have been reported in several observational studies [6,7,8,9]
The primary objective of this study was to determine whether the levels of platelet activation are elevated in treatment naïve patients with HIV, while the secondary objective was to determine whether the levels of platelet activation are attenuated, following successful ART
Summary
Antiretroviral therapy (ART) alters platelet reactivity, and as a consequence, patients living with HIV may be at an increased risk of cardiovascular disease (CVD). The current evidence on platelet activation levels in patients with HIV remains inconclusive. Incongruent findings on the levels of platelets activation in PLWHIV have been reported in several observational studies [6,7,8,9]. Antiretroviral drugs have been shown to directly activate platelets, in vitro [10], while individual observational studies have reported on conflicting findings of attenuated [6, 11] and persistently elevated levels of platelet activation following initiation of ART [7,8,9, 12, 13]. The importance and clinical relevance of evaluating platelet activation in the thrombotic-risk stratification of PLWHIV on ART is confounded by variance in the study setting, duration of ART exposure and differences in the methods of enumerating activated peripheral blood platelets
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