Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
AIDS Patient Care STDS. 2009 Dec;23(12):1001-7. doi: 10.1089/apc.2009.0173.
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.
与健康对照组相比，HIV 感染患者的动静脉血栓形成发生率增加。在这项横断面分析中，我们测量了内皮细胞激活标志物、凝血酶生成、纤维蛋白溶解以及抗凝和内源性凝血酶潜能（ETP）和活化蛋白 C 敏感性比（APCsr）作为更全面的标志物。我们纳入了 160 例连续 HIV 感染患者，中位年龄 46 岁（范围，27-77），其中 92%为男性，74%为白种人，11%为非裔美国人，9%为西班牙裔，6%为亚洲人。同性接触是主要的传播方式。70%的患者正在接受联合抗逆转录病毒治疗（cART）。在 83%的患者中，观察到实验室标志物超出非 HIV 感染人群的正常范围。与未接受 cART 的患者相比，接受 cART 的 HIV 感染患者的血管性血友病因子（vWF；p = 0.03）、VIII 因子（p < 0.0001）、D-二聚体（p = 0.01）和 ETP（p = 0.01）水平显著降低。未接受 cART 的 HIV 感染患者的蛋白 C（p = 0.05）和游离蛋白 S（p < 0.0001）水平降低，APCsr 升高（p < 0.0001）。仅观察到纤维蛋白原水平升高与蛋白酶抑制剂的使用之间存在单一关联（p = 0.002）。在接受包含阿巴卡韦、司他夫定或去羟肌苷与其他核苷逆转录酶抑制剂的 cART 方案的患者与其他患者之间，实验室标志物超出正常范围的患者百分比无显著差异。尽管接受 cART 的 HIV 感染患者的凝血异常发生率较低，但相当一部分接受 cART 的 HIV 感染患者表现出内皮细胞激活和 APCsr 升高，提示存在持续的促凝状态。
