Articles

Extrinsic and Intrinsic Coagulation Pathway, Fibrinogen Serum Level and Platelet Count in HIV Positive Patients

Abstract

Infection with human immunodeficiency virus (HIV) is a progressive condition which may cause endothelial dysfunction and liver damage leading to coagulopathy. With adventure of highly active antiretroviral therapy (HAART), life expectancy has prolonged in HIV positive patients but several acquired immunodeficiency syndrome (AIDS)-related conditions such as coagulopathies are responsible for associated morbidity and mortality. This study aimed to evaluate the extrinsic and intrinsic pathways of coagulation, serum level of fibrinogen and platelet count in HIV positive patients and compare it with negative healthy individuals. Through a case-control study, 114 HIV seropositive patients were compared with 114 seronegative samples in terms of hematological and other coagulation parameters. Mean age of study patients was 37.48 years. Intra venous drug abuse was the most common route of infection transmission with a prevalence of more than 50%. HIV route of transmission had a direct relationship with PTT abnormal levels (P<0.0001). However, this relationship was not significant for PT values. Stages of HIV disease and administration of HAART did not reveal any significant relationship with PT and PTT. There was also a statistically significant correlation between CD4+< 200 and PT in case group (P=0.008). On the other hands, in control group, CD4+ had a weak relationship with PTT (P=0.02) and an inverse correlation with serum fibrinogen (P=0.013). Hematological parameters and serum fibrinogen are decreased in HIV positive patients especially in direct relation with CD4+ cell count<200 cell/µl. PT and PTT abnormal values are also more prevalent in this population.

Sullivan PS, Dworkin MS, Jones JL, Hooper WC. Epidemiology of thrombosis in HIV-infected individuals. AIDS 2000;14(3):321-4.

Fultz SL, McGinnis KA, Skanderson M, Ragni MV, Justice AC. Association of venous thromboembolism with human immunodeficiency virus and mortality in veterans. Am J Med 2004;116(6):420-3.

Lijfering WM, Ten Kate MK, Sprenger HG, van der MeerJ. Absolute risk of venous and arterial thrombosis in HIVinfected patients and effects of combination antiretroviral therapy. J Thromb Haemost 2006;4(9):1928-30.

Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003;348(8):702-10.

Esmon CT, al. e. Inflammation, sepsis, and coagulation. Haematologica 1999;84(3):254-9.

Levi M, ten Cate H, van der Poll T. Disseminated intravascular coagulation: State of the art. Thromb Haemost 1999;82(2):695-705.

Levi M, van der Poll T, ten Cate H, van Deventer SJ. The cytokine-mediated imbalance between coagula and anticoagulant mechanisms in sepsis and endotoxaemia. Eur Clin Invest 1997;27(1):3-9.

Osterud B, Bjorklid E. The tissue factor pathway in disseminated intravascular coagulation. Semin Thromb Hemost 2001;27(6):605-17.

Hack CE. Tissue factor pathway of coagulation in sepsis.Crit Care Med 2000;28(9 Suppl):S25-30.

Nawroth PP, Handley DA, Esmon CT, Stern DM. Interleukin 1 induces endothelial cell procoagulant while suppressing cell-surface anticoagulant activity. Proc Natl Acad Sci USA 1986;83(10):3460-4.

ten Cate JW, van der Poll T, Levi M, ten Cate H, van Deventer SJ. Cytokines: triggers of clinical thromboticdisease. Thromb Haemost1997;78(1):415-9.

Aird WC. Vascular bed-specific hemostasis: role of endothelium in sepsis pathogenesis. Crit Care Med 2001;29(7 Suppl):S28-S34.

Levi M, ten Cate H, van der Poll T. Endothelium: interface between coagulation and inflammation. Crit Care Med,2002;30(5 Suppl):S220-S4.

Karpatkin S, Nardi M, Green D. Platelet and coagulation defects associated with HIV-I-infection. Thromb Haemost 2002;88(3):389-01.

Vallance P, Collier J, Bhagat K. Infection, inflammation and infarction; does acute endothelial dysfunction provide a link? Lancet 1997;349(9062):1391-2.

Verma S, Anderson JJ. Fundamentals of endothelial function for the clinical cardiologist. Circulation 2002;105(5):546-9.

Andrade ACO, Cotter BR. Endothelial function and cardiovascular disease in HIV infected patient. Brazillian J Infect Dis 2006;10(2)139-5.

Oguntibeju OO, van den Heever WMJ, Van Schalkwyk FE. Effect of liquid nutritional supplement on viral load and haematolgoical parameters in HIV-positive/AIDS patients. Br J Biomed Sci 2006;63(3):134-9.

Omoregie R, Osakue SI, Ihemeje V, Omokaro EU, Ogefere HO. Correlation of CD4 Count with Platelet,Count, Prothrombin Time and Activated Partial Thromboplastin Time among HIV Patients in Benin City,Nigeria. West Indian Med J 2009;58(5):437.

Nakao S, Lai CJ, Young NS. Dengue virus, a flavivirus,propagates in human bone marrow progenitors and hematopoietic cell lines. Blood 1989;74(4):1235-40.

Levi M, Keller TT, Van Gorp E, Ten Cate H. Infection and inflammation and the coagulation system. Cardiovascular Research 2003;60(1):26-39.

Palella FJJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients withadvanced human immunodeficiency virus infection. HIVOutpatient Study Investigators. N Engl J Med 1998;338(13):853-60.

Murphy EL, Collier AC, Kalish LA, Assmann SF, Para MF, Flanigan TP, Kumar PN, Mintz L, Wallach FR, NemoGJ; Viral Activation Transfusion Study Investigators. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease Ann Inter Med 2001 2001;135(1):17-26.

Mocroft A, Reiss P, Gasiorowski J, Ledergerber B, Kowalska J, Chiesi A, Gatell J, Rakhmanova A, Johnson M, Kirk O, Lundgren J; EuroSIDA Study Group. Serious fatal and non fatal non AIDS defining illnesses in Europe. J Acquir Immune Defic Syndr 2010;55(2):262-70.

Copur AS, Smith PR, Gomez V, Bergman M, Homel P. HIV infection is a risk factor for venous thromboembolism AIDS Patient Care STDS 2002;16(5):205-9.

Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of anemia in human immunodeficiencym virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 1998;91(1):301-8.

Wolf K, Tsakiris DA, Weber R, Erb P, Battegay M. Swiss HIV Cohort Study. Antiretroviral Therapy Reduces Markers of Endothelial and Coagulation Activation in Patients Infected with Human Immunodeficiency Virus Type 1. The Journal of Infectious Diseases 2002;185(4):456-62.

Najean Y, Rain JD. The Mechanism of thrombocytopenia in patients with HIV. J Lab Clin Med 1994;123(3):415-20.

Kirchhoff F, Silvestri G. Is Nef the elusive cause of HIVassociated hematopoietic dysfunction? J Clin Invest 2008;118(5):1622-5.

Hooper WC, Phillips DJ, Ribeiro MJ, Benson JM, George VG, Ades EW, Evatt BL. Tumor necrosis factor-alpha downregulates protein S secretion in human microvascular and umbilical vein endothelial cells but not in the HepG-2 hepatoma cell line. Blood 1994;84(2):483-9.

Bergamini A, Faggioli E, Bolacchi F, Gessani S, Cappannoli L, Uccella I, Demin F, Capozzi M, Cicconi R,Placido R, Vendetti S, Colizzi GM, Rocchi G. Enhanced production of tumor necrosis factor-alpha and interleukin-6 due to prolonged response to lipopolysaccharide in human macrophages infected in vitro with human immunodeficiency virus type 1. J Infect Dis 1999;179(4):832-42.

Lijfering WM, Sprenger HG, Georg RR, van der Meulen PA, van der Meer J. Relationship between Progression to AIDS and Thrombophilic Abnormalities in HIV Infection. Clinical Chemistry 2008;54(7):1226-33.

Dikshit B, Wanchu A, Kaur Sachdeva R, Sharma A, Das R. Profile of hematological abnormalities of Indian HIV infected individuals. BMC Blood Disorders 2009;9:5.

Files
IssueVol 51, No 7 (2013) QRcode
SectionArticles
Keywords
Human Immunodeficiency Virus Coagulation Pathway Fibrinogen Platelet

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Abdollahi A, Shoar N, Shoar S, Rasoulinejad M. Extrinsic and Intrinsic Coagulation Pathway, Fibrinogen Serum Level and Platelet Count in HIV Positive Patients. Acta Med Iran. 1;51(7):472-476.