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Coagulation Parameters in Human Immunodeficiency Virus Infected Patients: A Systematic Review and Meta-Analysis. AIDS Res Treat 2022; 2022:6782595. [PMID: 35492260 PMCID: PMC9050251 DOI: 10.1155/2022/6782595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coagulation abnormalities are common complications of human immunodeficiency virus (HIV) infection. Highly active antiretroviral treatment (HAART) decreased the mortality of HIV but increased coagulopathies. HIV-related thrombocytopenia, prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), and high D-dimer level commonly manifested in patients with HIV. Thus, this study is aimed to compare coagulation parameters of HAART-treated and HAART-naïve HIV-infected patients with HIV-seronegative controls. Methods A systematic literature search was conducted using the databases PubMed/MEDLINE, Embase, Web of Science, and Google Scholar of studies published until July 2021. The primary outcome of interest was determining the pooled mean difference of coagulation parameters between HIV-infected patients and seronegative controls. The Joana Briggs Institute (JBI) critical appraisal tool was used for quality appraisal. Statistical analyses were performed using Stata11.0 software. The statistical results were expressed as the effect measured by standardized mean difference (SMD) with their related 95% confidence interval (CI). Results A total of 7,498 participants (1,144 HAART-naïve patients and 2,270 HAART-treated HIV-infected patients and 3,584 HIV-seronegative controls) from 18 studies were included. HIV-infected patients (both on HAART and HAART-naive) exhibited significantly higher levels of PT than HIV-seronegative controls (SMD = 0.66; 95% CI: 0.53–0.80 and SMD = 1.13; 95% CI: 0.60–2.0, respectively). The value of APTT was significantly higher in patients with HIV on HAART than in seronegative controls. However, the values of PLT count, APTT, and fibrinogen level were significantly higher in seronegative controls. Besides, the level of fibrinogen was significantly higher in HAART-treated than treatment-naïve patients (SMD = 0.32; 95%CI: 0.08, 0.57). Moreover, the level of APTT and PT had no statistical difference between HAART and HAART-naïve HIV-infected patients. Conclusions This study identified that HIV-infected patients are more likely to develop coagulation abnormalities than HIV-seronegative controls. Therefore, coagulation parameters should be assessed regularly to prevent and monitor coagulation disorders in HIV-infected patients.
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Gabrick KS, Chouiari F, Park KE, Allam O, Mozaffari MA, Persing JA, Alperovich M. A comparison of perioperative safety for breast augmentation in cis- vs. trans patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:601. [PMID: 33987299 DOI: 10.21037/atm-20-3355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Gender-affirming surgery provides a psychosocial benefit to transgender women. However, increased medical complexity within the transgender population has limited access for some transgender women. This study compared patient population comorbidities and 30-day peri-operative safety following primary augmentation mammoplasty between cis- and transgender women. Methods Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database between 2007 and 2016. Transgender patients were identified using ICD-9 &10 codes for gender dysphoria. Categorical variables were compared using chi-squared and Fisher's exact tests while independent t-tests were used for continuous variables. Statistical significance was set at P<0.05. Results There were 4,234 breast augmentations identified in cisgender women and 137 in transgender women. Transgender women had a higher frequency of ASA-II and ASA-III patients (P<0.001), diabetes (P<0.001), hypertension (P=0.006), and active smoking status (P<0.001). Despite the higher comorbidity burden and routine use of hormonal therapy, there were no significant differences between populations in major or minor peri-operative complication rates. Conclusions Top surgery improves quality of life in transgender women. Despite the more complex pre-operative risk profile in the transgender population, there is no difference in peri-operative safety profiles. Plastic surgeons treating this patient population should consider more liberal surgical indications for reconstructive top surgery compared with cosmetic breast augmentation.
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Affiliation(s)
- Kyle S Gabrick
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Fouad Chouiari
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Kitae E Park
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Omar Allam
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | | | - John A Persing
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
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Coronavirus Disease of 2019 in Patients With Well-Controlled Human Immunodeficiency Virus on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2020; 85:e1-e4. [PMID: 32568765 PMCID: PMC7446988 DOI: 10.1097/qai.0000000000002415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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Arnold JD, Sarkodie EP, Coleman ME, Goldstein DA. Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol. J Sex Med 2016; 13:1773-1777. [DOI: 10.1016/j.jsxm.2016.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 11/24/2022]
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Effect of antiretroviral therapy in thromboregulation through the hydrolysis of adenine nucleotides in platelets of HIV patients. Biomed Pharmacother 2016; 79:321-8. [PMID: 27044844 DOI: 10.1016/j.biopha.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/08/2015] [Accepted: 02/23/2016] [Indexed: 01/16/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection results in biochemical and vascular dysfunctions. The highly active antiretroviral therapy (HAART) markedly reduces mortality and opportunistic diseases associated with acquired immunodeficiency syndrome (AIDS). This increased survival time predisposes the development of cardiovascular diseases. Platelets present purinergic system ectoenzymes such as E-NTPDase, E-5'-nucleotidase and E-ADA on its surface. In view of this, the aim of this study was to evaluate the activity of these ectoenzymes in platelets as well as the platelet aggregation and lipid profile of patients with HIV infection and also patients receiving HAART. The results showed an increase in the E-NTPDase activity for ATP hydrolysis in the HIV group compared with the control group and the HIV/HAART group. When assessing the activity E-NTPDase hydrolysis to ADP, the results revealed an increase in activity in the HIV group when compared to the control group, and a decrease in activity when in the HIV/HAART group when compared to the control and HIV groups. The activity of E-5'-nucleotidase revealed an increase in AMP hydrolysis in the HIV group, as the results from control and HIV/HAART groups showed no statistical difference. Regarding the E-ADA activity, the HIV and HIV/HAART groups revealed a decreased deamination of adenosine when compared with the control group. Furthermore, we observed an increased platelet aggregation of HIV/HAART group compared with the control group. Thus, our results suggest that antiretroviral treatment against HIV has a significant effect on the activity of purinergic system ectoenzymes demonstrating that thromboregulation is involved in the process.
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van den Dries LWJ, Gruters RA, Hövels-van der Borden SBC, Kruip MJHA, de Maat MPM, van Gorp ECM, van der Ende ME. von Willebrand Factor is elevated in HIV patients with a history of thrombosis. Front Microbiol 2015; 6:180. [PMID: 25814984 PMCID: PMC4356086 DOI: 10.3389/fmicb.2015.00180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/19/2015] [Indexed: 11/21/2022] Open
Abstract
Background: Arterial and venous thrombotic events are more prevalent in HIV infected individuals compared to the general population, even in the era of combination antiretroviral therapy. Although the mechanism is not fully understood, recent evidence suggests a role for chronic immune activation. Methods: We reviewed the Dutch National HIV registry database for HIV infected patients in Rotterdam with a history of arterial or venous thrombosis and calculated the incidence. We collected samples from patients with and without thrombosis and compared plasma levels of lipopolysaccharide (LPS), LPS binding protein (LBP), soluble CD14 (sCD14), and von Willebrand Factor antigen level (vWF). Results: During a 10-year period, a total of 60 documented events in 14,026 person years of observation (PYO) occurred, resulting in an incidence rate of 2.50, 2.21, and 4.28 for arterial, venous and combined thrombotic events per 1000 PYO, respectively. The vWF was elevated in the majority of study subjects (mean 2.36 SD ± 0.88 IU/ml); we found a significant difference when comparing venous cases to controls (mean 2.68 SD ± 0.82 IU/ml vs. 2.20 SD ± 0.77 IU/ml; p = 0.024). This difference remained significant for recurrent events (mean 2.78 SD ± 0.75; p = 0.043). sCD14 was positively correlated with LPS (r = 0.255; p = 0.003). Conclusion: The incidence of venous thrombosis was two-fold higher in HIV infected patients compared to age-adjusted data from general population cohort studies. We couldn't find a clear association between immune activation markers to either arterial or venous thrombotic events. We observed a marked increase in vWF levels as well as a correlation of vWF to first and recurrent venous thrombo-embolic events. These findings suggest that HIV infection is an independent risk factor for coagulation abnormalities and could contribute to the observed high incidence in venous thrombosis. This could be a reason to prolong anti-thrombotic treatment in HIV patients with a history of thrombosis.
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Affiliation(s)
| | - Rob A Gruters
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | | | - Marieke J H A Kruip
- Division of Hematology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Moniek P M de Maat
- Division of Hematology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Netherlands ; Division of Infectious Diseases, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Marchina E van der Ende
- Division of Infectious Diseases, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Netherlands
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Abstract
Purpose There is a limited source of information about vascular access outcomes in HIV-positive patients in the literature. Previous studies have shown autogenous arteriovenous fistulae (AVF) to have similar cumulative survival rates in HIV-positive and negative patients but functional patency has not been assessed. The primary aim of this study was to investigate functional patency of AVFs in HIV-positive patients. Methods A retrospective case-control study identifying 17 HIV-positive patients with AVFs under the care of renal services at Kings College Hospital, London was undertaken. Seventeen HIV-negative controls were matched for age, sex, ethnicity, and co-morbidities. Comparisons were made for pre-operative vein diameter, primary and functional patencies, and postoperative complications. Results No statistically significant difference was seen for functional patency between AVFs in the HIV-positive and control groups (P=.078). Complications were experienced by five HIV-positive patients (29.4%) and nine of the control group (52.9%). These included aneurysms and pseudoaneurysms for both groups. The difference in pre-operative vein diameter was not significant (P=.102), although only five of the HIV-positive patients had pre-operative vein diameters >=2.5 mm (45.5%) compared to twelve of the controls (75%). Conclusions This study reveals that there is no statistically significant difference between the functional patency of autogenous AVFs in HIV-positive patients compared to HIV-negative controls. With less than half of the HIV-positive patients having pre-operative vein diameters >=2.5 mm, this suggests that it is still worth creating AVFs in patients with sub-optimal veins considering the known poorer patency with non-autogenous fistulae.
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Becker AC, Jacobson B, Singh S, Sliwa K, Stewart S, Libhaber E, Essop MR. The thrombotic profile of treatment-naive HIV-positive Black South Africans with acute coronary syndromes. Clin Appl Thromb Hemost 2010; 17:264-72. [PMID: 20460356 DOI: 10.1177/1076029609358883] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection on protease inhibitors (PIs) have a heightened risk of arterial thrombosis but little is known about treatment-naive patients. METHODS/RESULTS Prospective study from South Africa comparing thrombotic profiles of HIV-positive and -negative patients with acute coronary syndrome (ACS). A total of 30 treatment-naive HIV-positive patients with ACS were compared to 30 HIV-negative patients with ACS. Patients with HIV were younger; and besides smoking (73% vs 33%) and low high-density lipoprotein (HDL; 0.8 ± 0.3 vs 1.1 ± 0.4), they had fewer risk factors. Thrombophilia was more common in HIV-positive patients with lower protein C (PC; 82 ± 22 vs 108 ± 20) and higher factor VIII levels (201 ± 87 vs 136 ± 45). Patients with HIV had higher frequencies of anticardiolipin (aCL; 47% vs 10%) and antiprothrombin antibodies (87% vs 21%). CONCLUSION Treatment-naive HIV-positive patients with ACS are younger, with fewer traditional risk factors but a greater degree of thrombophilia compared with HIV-negative patients.
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Affiliation(s)
- A C Becker
- Division of Cardiology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
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Jong E, Louw S, Meijers JC, de Kruif MD, ten Cate H, Büller HR, Mulder JW, van Gorp EC. The hemostatic balance in HIV-infected patients with and without antiretroviral therapy: partial restoration with antiretroviral therapy. AIDS Patient Care STDS 2009; 23:1001-7. [PMID: 19929230 DOI: 10.1089/apc.2009.0173] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The incidence of arterial and venous thrombosis in HIV-infected patients is increased compared to healthy controls. In this cross-sectional analysis we measured markers of endothelial cell activation, thrombin generation, fibrinolysis and anticoagulation combined with endogenous thrombin potential (ETP) and activated protein C sensitivity ratio (APCsr) as more global markers. We included 160 consecutive HIV-infected patients with a median age of 46 years (range, 27-77), of whom 92% were male, 74% Caucasian, 11% African American, 9% Hispanic, and 6% Asian. Homosexual contact was the main transmission mode. Seventy percent of patients were using combined antiretroviral therapy (cART). In 83% of patients laboratory markers outside the normal range for a non-HIV-infected population were observed. Significant lower levels of von Willebrand factor (vWF; p = 0.03), factor VIII (p < 0.0001), D-dimer (p = 0.01), and ETP (p = 0.01) were observed in HIV-infected patients on cART compared to patients not on cART. Significant lower levels of protein C (p = 0.05) and free protein S (p < 0.0001), and increased APCsr (p < 0.0001) were found in the HIV-infected patients not on cART. A single association was observed between raised levels of fibrinogen and use of a protease inhibitor (p = 0.002). No significant difference was observed in the percentage of patients with laboratory markers outside the normal range between patients using cART-regimens containing abacavir, stavudine, or didanosine and those with other nucleoside reverse transcriptase inhibitors. Although the prevalence of coagulation abnormalities was lower in HIV-infected patients using cART, a considerable proportion of HIV-infected patients on cART show endothelial cell activation and increased APCsr, suggestive of a persistent procoagulant state.
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Affiliation(s)
- Eefje Jong
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Susan Louw
- Department of Hematology, Johannesburg General Hospital, Johannesburg, South Africa
| | - Joost C.M. Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Martijn D. de Kruif
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Hugo ten Cate
- Department of Internal Medicine, Laboratory for Clinical Thrombosis and Hemostasis, University Hospital Maastricht and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Harry R. Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Willem Mulder
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Eric C.M. van Gorp
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
- Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands
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Crum-Cianflone NF, Weekes J, Bavaro M. Review: thromboses among HIV-infected patients during the highly active antiretroviral therapy era. AIDS Patient Care STDS 2008; 22:771-8. [PMID: 18783326 PMCID: PMC2753452 DOI: 10.1089/apc.2008.0010] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Venous thrombotic events (VTEs) may occur at higher rates among patients with HIV; some studies suggest that highly active antiretroviral therapy (HAART) may increase the risk for these potentially life-threatening events. We performed a retrospective study among patients with HIV to evaluate the incidence and risk factors for VTEs during the HAART era. A literature review was performed examining VTEs in the pre- and post-HAART eras. Seventeen (3.7%) of 465 patients with HIV experienced a VTE. The overall incidence rate of deep VTEs among HIV-positive persons was 377 cases per 100,000 person-years, a fourfold higher rate compared to age-matched males in the general population. The median age at VTE was 36 years (range, 27-68). Patients with a thrombosis compared to those without had significantly lower current CD4 (153 versus 520 cells/mm(3), p < 0.001) and nadir (76 versus 276 cells/mm(3), p < 0.001) CD4 counts, higher viral loads (3.6 versus 1.7 log(10) copies per milliliter, p = 0.003), and more likely to have a diagnosis of AIDS (76% versus 32%, p < 0.001); there were no differences in demographics, hyperlipidemia, current use of HAART, the duration of HAART or protease inhibitor (PI) exposure. A review of the literature noted 129 VTE cases; mean age was 40 years, mean CD4 count was 181 cells/mm(3), the majority of patients were not receiving HAART, and the most common risk factor was an ongoing infection. Thrombotic events are occurring among patients with HIV despite their relatively young ages. Advanced HIV disease is a risk factor for development of thromboses, possibly due to an increased inflammatory state or the presence of concurrent comorbidities such as infections. HAART or PI therapy does not appear to play a significant role in the occurrence of VTEs.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Infectious Diseases Department, Naval Medical Center San Diego, San Diego, California 92134-1005, USA.
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Venous thromboembolism in HIV-positive women during puerperium: a case series. Blood Coagul Fibrinolysis 2008; 19:95-7. [DOI: 10.1097/mbc.0b013e3282f38c23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thompson GR, Lawrence VA, Crawford GE. HIV infection increases the risk of heparin-induced thrombocytopenia. Clin Infect Dis 2007; 45:1393-6. [PMID: 17968841 DOI: 10.1086/522761] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/25/2007] [Indexed: 11/03/2022] Open
Abstract
The incidence of heparin-induced thrombocytopenia in human immunodeficiency virus (HIV)-infected inpatients was compared with that in a control group that was not known to be infected with HIV in a retrospective cohort study. HIV-infected patients receiving heparin therapy, especially unfractionated heparin therapy, were at increased risk of developing heparin-induced thrombocytopenia, compared with HIV-uninfected patients.
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Affiliation(s)
- George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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