TY - JOUR
T1 - HIV is associated with thrombophilia and high D-dimer in children and adolescents
AU - Pontrelli, Giuseppe
AU - Martino, Alessandra M.
AU - Tchidjou, Hyppolite K.
AU - Citton, Rita
AU - Mora, Nadia
AU - Ravà, Lucilla
AU - Tozzi, Alberto E.
AU - Palma, Paolo
AU - Muraca, Maurizio
AU - Franco, Elisabetta
AU - Rossi, Paolo
AU - Bernardi, Stefania
PY - 2010/5
Y1 - 2010/5
N2 - Background and 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 μg/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.
AB - Background and 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 μg/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.
KW - D-dimer
KW - HIV
KW - Paediatric
KW - Protein S
KW - Thrombophilia
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U2 - 10.1097/QAD.0b013e328337b9a0
DO - 10.1097/QAD.0b013e328337b9a0
M3 - Article
C2 - 20168205
AN - SCOPUS:77951804888
VL - 24
SP - 1145
EP - 1151
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 8
ER -