title: Platelet reactivity in human immunodeficiency virus infected patients on dual antiplatelet therapy for an acute coronary syndrome: the EVERE2ST-HIV study.
abstract: OBJECTIVE
  To explore platelet reactivity on dual antiplatelet therapy (DAPT) of acute coronary syndrome (ACS) patients infected with HIV.
  
  
  RESULTS
  Acute coronary syndrome patients infected with HIV (n = 80) were matched to ACS patients without HIV (n = 160) on age, sex, diabetes, and DAPT (aspirin 100%, clopidogrel 68%, prasugrel 31%, ticagrelor 1%). Platelet reactivity was evaluated after ACS (>30 days) by measuring residual platelet aggregation (RPA) to aspirin and to P2Y12 inhibitors with light transmission aggregometry (LTA), VerifyNow aspirin assay (ARU), and P2Y12 assay (PRU) and with the VASP platelet reactivity index (VASP-PRI). Proportion of patients with high residual platelet reactivity (HPR) was evaluated. HIV-infected ACS patients had higher levels of platelet reactivity in response to P2Y12 inhibitors (RPA: 23.8 ± 2.7% vs. 15.3 ± 1.3%; P = 0.001; PRU: 132 ± 10 vs. 107.4 ± 6.6; P = 0.04; and VASP-PRI: 45.2 ± 2.6% vs. 32.0 ± 2.0%; P < 0.001) and to aspirin (RPA: 3.6 ± 1.5% vs. 0.4 ± 0.1%; P = 0.004 and ARU: 442 ± 11 vs. 407 ± 5; P = 0.002) compared with non-HIV. HIV-infection was independently associated with increased platelet reactivity regardless of the test used (RPA: P = 0.005; PRU: P < 0.001 and VASP-PRI: P < 0.001) and a higher proportion of HPR (OR = 7.6; P < 0.001; OR = 2.06; P = 0.06; OR = 2.91; P = 0.004, respectively) in response to P2Y12 inhibitors. Similar results were found with aspirin. Protease inhibitors use was associated with increased platelet reactivity and higher rate of HPR.
  
  
  CONCLUSIONS
  Acute coronary syndrome patients infected with HIV have increased levels of platelet reactivity and higher prevalence of HPR to P2Y12 inhibitors and aspirin than non-HIV patients. These results could provide potential explanations for the observed increase risk of recurrent ischemic events in the HIV-infected population.
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Hauguel-Moreau
authors.affiliation: Sorbonne Universités, Univ Paris 06 (UPMC), Service de cardiologie, Hôpital Saint-Antoine, (AP-HP), Paris, France.|INSERM, UMR_S 938, UPMC, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Boccara
authors.affiliation: Sorbonne Universités, Univ Paris 06 (UPMC), INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.
authors.forename: Anders
authors.initials: A
authors.lastname: Boyd
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, AP-HP, INSERM, CIC-1421, Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière Hospital, Paris, F-75013, France.
authors.forename: Joe-Elie
authors.initials: JE
authors.lastname: Salem
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Brugier
authors.affiliation: Sorbonne Universités, Univ Paris 06 (UPMC), Service de cardiologie, Hôpital Saint-Antoine, (AP-HP), Paris, France.
authors.forename: Angélique
authors.initials: A
authors.lastname: Curjol
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, AP-HP, INSERM, CIC-1421, Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière Hospital, Paris, F-75013, France.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Hulot
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Galier
authors.affiliation: Sorbonne Universités, Univ Paris 06 (UPMC), Service de cardiologie, Hôpital Saint-Antoine, (AP-HP), Paris, France.
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Sorbonne Université - Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, ICAN, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage; D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage*; D012008:Recurrence; D012307:Risk Factors; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D019380:Anti-HIV Agents; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: Acute coronary syndromes; Antiretroviral therapy; Dual antiplatelet therapy; Human immunodeficiency virus; Platelet reactivity