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) regimenemtricitabine,
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 : The DVT patients (HIV positive and HIV negative) had raised inflammatory markers. The HIV positive-DVT
group had anaemia in keeping with anaemia of chronic disorders. DVT patients had 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 DVT patient’s red blood cells (RBCs)
and platelets demonstrated 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 : Although there were trends that HIV-positive patients were more hypercoagulable on functional tests
(viscoelastic profile) compared to HIV-negative patients, there were no significant differences between the 2 groups.
The sample size was, however, small in number. Morphologically there were inflammatory changes in patients with
DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV-positive
patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.
