Evaluation of First-Line Coagulation Tests in Highly Active Antiretroviral Therapy (HAART) Naïve and Treated Group of HIV Infected Subjects

Background: Coagulation disorders are common in patients with Human Immunodeficiency virus (HIV). Coagulation abnormalities occur as a result of HIV-related thrombocytopenia, induced hepatotoxicity due to highly active antiretroviral therapy (HAART) that impairs liver function and diminishes the function and synthesis of coagulation factors. The aim of this study was to evaluate prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count, mean platelet volume, plateletcrit and platelet distribution width in HAART-naïve HIV infected patients, HAART treated and HIV-seronegative controls.

Place and Duration of Study: Department of Haematology and antiretroviraltherapies (ART) clinic both of Enugu State University of Science and Technology Teaching Hospital, between March and June 2023.

Methodology: A total of 150 study participants, consisting of 50 HAART-naïve HIV-infected subjects, 50 HIV-infected subjects who were taking HAART, and 50 HIV-seronegative apparently healthy subjects, were included. Coagulation tests such as PT, APTT were determined by manual procedures. Platelet counts (PC), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW) were analyzed by Mindray/BC-5150 automated analyzer. The data were analyzed using SPSS version 21. Analysis of variance (ANOVA) and Pearson correlation analysis were used. P-Value < 0.05 was considered as statistically significant.

Results: Mild thrombocytopenia (100-<150 x 109/L) was found in 48% of HIV-infected subjects who were taking HAART, 76% mild thrombocytopenia and 24% moderate thrombocytopenia (50-<100 x109/L) was found in HAART-naïve HIV-infected subjects, but no thrombocytopenia was found in apparently healthy HIV-seronegative control. Prothrombin time and APTT were significantly higher, whereas PC and PDW was significantly lower in HIV-infected subjects (both who were taking HAART and HAART-naïve) than HIV-seronegative subjects (p<0.05). Prothrombin time and APTT were significantly higher, and PC was significantly lower in HAART-naïve HIV-infected subjects than HIV-infected subjects who were taking HAART. In Pearson correlation analysis, PT and APTT has shown a significant negative correlation with a PC in those taking HAART and HAART-naïve HIV-infected subjects, whereas significant positive correlation was found in HIV-seronegative subjects.

Conclusion: Prothrombin time and APTT significantly increased, whereas platelet count and PDW significantly decreased in HIV-infected subjects who were taking HAART and HAART-naïve. Basic coagulation parameters need to be monitored regularly in HIV-infected subjects in Enugu.