Haematological parameters and pathological clotting in deep vein thrombosis and patients with HIV
Abstract Background. Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. Methods. We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen- Emtricitabine, Tenofovir and Efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties (using thromboelastography-TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups.Results. DVT patients (HIV positive and HIV negative) have anaemia with raised inflammatory markers which are more pronounced in HIV positive patients. HIV positive-DVT patients also have a microcytic hypochromic anaemia. DVT patients have a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of HIV positive-DVT patient’s red blood cells (RBCs) and platelets demonstrates inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. Conclusions. HIV positive patients have an increased hypercoagulability and DVT prevalence. Our results point to the importance of looking at the coagulation system function in HIV infected individuals with DVT. Parameters like haematological markers, coagulation tests (activated partial thromboplastin time and prothrombin time / International normalized ratio), thromboelastography and global clotting tests should be used as standard indicators of hypercoagulation and part of standard clinical practice.