HIV is associated with thrombophilia and high D-dimer in children and adolescents.
OBJECTIVE
Atherosclerosis and other cardiovascular diseases associated with thrombosis appear more relevant and anticipated in HIV-infected patients after combination antiretroviral therapy (cART) has reduced AIDS-related diseases and has improved survival. The association between viral replication and coagulation abnormalities in a cohort of HIV-infected children and adolescents was investigated here.


METHODS
Protein S, protein C anticoagulant and antithrombin activity, together with fibrinogen, D-dimer, high-sensitive C-reactive protein and homocysteine were assayed in a cross-sectional study among a cohort of HIV-infected children and adolescents. Results in patients with high viral load (HVL, HIV-RNA > 1000 copies/ml) were compared with those in patients with a lower replication (LVL), adjusting for other demographic, clinical and therapeutic covariates.


RESULTS
Eighty-eight patients (mean age 13.5 years, CD4 30%, 72% with LVL) were enrolled. A prevalence of protein S and protein C deficiency of 51 and 8% was, respectively, found. HVL group compared to LVL showed a significant reduction of protein S, protein C and antithrombin activities, and an increase of D-dimer levels. The independent association of HVL with decreased protein S activity (-11.2%, P = 0.04) and increased D-dimer levels (+0.13 microg/ml, P = 0.004) was confirmed in the multivariate model.


CONCLUSIONS
HIV-infected children and adolescents present high prevalence of thrombophilic abnormalities. The multivariate model confirmed that high viral replication is independently associated with decrease of protein S and increase of D-dimer, suggesting the advantage of suppressive therapy on coagulation homeostasis and the opportunity of an active control of cardiovascular risk factors starting at a younger age.
Pontrelli
Giuseppe
G
Department of Public Health,Ospedale Pediatrico Bambino Gesù, Rome, Italy. giuseppe.pontrelli@opbg.net
Martino
Alessandra M
AM
Tchidjou
Hyppolite K
HK
Citton
Rita
R
Mora
Nadia
N
Ravà
Lucilla
L
Tozzi
Alberto E
AE
Palma
Paolo
P
Muraca
Maurizio
M
Franco
Elisabetta
E
Rossi
Paolo
P
Bernardi
Stefania
S
D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D050197:Atherosclerosis / Q000188:drug therapy / Q000821:virology*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000008:administration & dosage / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D019851:Thrombophilia / Q000188:drug therapy / Q000821:virology*; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects
D044966:Anti-Retroviral Agents; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein