Department of Public Health,Ospedale Pediatrico Bambino Gesù, Rome, Italy.
AIDS. 2010 May 15;24(8):1145-51. doi: 10.1097/QAD.0b013e328337b9a0.
Atherosclerosis and other cardiovascular diseases associated with thrombosis appear more relevant and anticipated in HIV-infected patients after combination antiretroviral therapy (cART) has reduced AIDS-related diseases and has improved survival. The association between viral replication and coagulation abnormalities in a cohort of HIV-infected children and adolescents was investigated here.
Protein S, protein C anticoagulant and antithrombin activity, together with fibrinogen, D-dimer, high-sensitive C-reactive protein and homocysteine were assayed in a cross-sectional study among a cohort of HIV-infected children and adolescents. Results in patients with high viral load (HVL, HIV-RNA > 1000 copies/ml) were compared with those in patients with a lower replication (LVL), adjusting for other demographic, clinical and therapeutic covariates.
Eighty-eight patients (mean age 13.5 years, CD4 30%, 72% with LVL) were enrolled. A prevalence of protein S and protein C deficiency of 51 and 8% was, respectively, found. HVL group compared to LVL showed a significant reduction of protein S, protein C and antithrombin activities, and an increase of D-dimer levels. The independent association of HVL with decreased protein S activity (-11.2%, P = 0.04) and increased D-dimer levels (+0.13 microg/ml, P = 0.004) was confirmed in the multivariate model.
HIV-infected children and adolescents present high prevalence of thrombophilic abnormalities. The multivariate model confirmed that high viral replication is independently associated with decrease of protein S and increase of D-dimer, suggesting the advantage of suppressive therapy on coagulation homeostasis and the opportunity of an active control of cardiovascular risk factors starting at a younger age.
在联合抗逆转录病毒疗法（cART）降低艾滋病相关疾病并提高生存率后，艾滋病病毒（HIV）感染者中与血栓形成相关的动脉粥样硬化和其他心血管疾病似乎更为相关和预期。本研究旨在调查 HIV 感染儿童和青少年队列中病毒复制与凝血异常之间的关系。
在 HIV 感染儿童和青少年队列的横断面研究中，测定了蛋白 S、蛋白 C 抗凝和抗凝血酶活性以及纤维蛋白原、D-二聚体、高敏 C 反应蛋白和同型半胱氨酸。将高病毒载量（HIV-RNA > 1000 拷贝/ml，HVL）患者的结果与低复制（HIV-RNA < 1000 拷贝/ml，LVL）患者的结果进行比较，并调整了其他人口统计学、临床和治疗协变量。
共纳入 88 例患者（平均年龄 13.5 岁，CD4 30%，72%为 LVL）。分别发现蛋白 S 和蛋白 C 缺乏的发生率为 51%和 8%。与 LVL 组相比，HVL 组的蛋白 S、蛋白 C 和抗凝血酶活性显著降低，D-二聚体水平升高。在多变量模型中，HVL 与蛋白 S 活性降低（-11.2%，P = 0.04）和 D-二聚体水平升高（+0.13 microg/ml，P = 0.004）之间存在独立相关性。
HIV 感染的儿童和青少年存在高凝异常的高发生率。多变量模型证实，高病毒复制与蛋白 S 降低和 D-二聚体升高独立相关，这表明抑制治疗有利于凝血平衡，并为在更年轻时积极控制心血管危险因素提供了机会。
