Prothrombotic State in HIV: A Study on Protein C, Protein S, Homocysteine and Correlation with CD4 Counts

• Published in: Indian journal of medical microbiology Vol. 36; no. 2; pp. 201 - 206
• Main Authors: Khare, Swati, Kushwaha, Rashmi, Kumar, Ashutosh, Venkatesh, Vimala, Reddy, Himanshu D, Jain, Mili, Yusuf, Mohd, Singh, Uma Shankar
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01-04-2018; Wolters Kluwer India Pvt. Ltd; Elsevier Limited
• Subjects: Abnormalities; Adult; Anticoagulants; Antiplatelet therapy; Antiretroviral therapy; Aspirin; Bleeding; Blood platelets; CD4 antigen; CD4 count; CD4 Lymphocyte Count; Coagulation; Complications; Contraceptives; Female; Flow cytometry; Hematology; Hemoglobin; HIV; HIV Infections - metabolism; Homocysteine; Homocysteine - metabolism; Human immunodeficiency virus; Humans; Immunoglobulins; Infections; Inflammation; Male; Metabolism; Middle Aged; Oral contraceptives; Patients; Platelets; Protein C; Protein C - metabolism; Protein deficiency; Protein S; Protein S - metabolism; Proteins; Prothrombin; Quality control; Sexually transmitted diseases; Statistical analysis; STD; Thromboembolism; Thromboplastin; Thrombosis; Thrombosis - metabolism; Tuberculosis; Tumor necrosis factor-TNF; Viruses; Vitamin K; human immunodeficiency virus; thrombosis; CD4 count; coagulation
• ISSN: 0255-0857; 1998-3646
• DOI: 10.4103/ijmm.IJMM_15_414

Introduction: Human immunodeficiency virus (HIV) may result in variable haematological manifestations. Thrombotic events are more common among HIV-infected persons than the general population, possibly due to the increased inflammatory/hypercoagulable state and presence of concurrent comorbidities. Aims and Objectives: (1) Screen for coagulation abnormalities in HIV-infected patients. (2) Detect certain prothrombotic factors such as deficiency of protein C and protein S and elevation of homocysteine as possible precursors of coagulation defects in HIV patients. (3) Correlation of coagulation abnormalities with CD4 counts. Methods: A pilot study of 1-year duration conducted in the Department of Pathology in collaboration with ART centre, KGMU Lucknow. All diagnosed HIV-seropositive patients (n = 30) who were not taking Vitamin K, antithrombotic and antiplatelet drugs including aspirin, oral contraceptives and not having known protein C/S deficiency were included in the present study as cases. Apart from this, 30 age- and sex-matched healthy individuals were also included in the present study. Assessment of the bleeding time, prothrombin time and activated partial thromboplastin time, complete blood count was done. Protein C and S were measured by calorimetric assay. Serum homocysteine was measured by the semi-automated method. CD4 count was done by flow cytometry. Results: The findings of the present study suggest a relationship between HIV, its complications and thrombosis. The HIV-seropositive patients have reduced levels of haemoglobin, CD4 counts, platelet counts, mean platelet volume, protein C and S activity as compared to the healthy individuals. Thrombophilic abnormality in the form of hyperhomocysteinaemia is more frequent in HIV-infected patients. All these parameters have a definite correlation with CD4 count.