Gaffrée and Guinle University Hospital, Postgraduate Program in Neuroscience / Neurology, Federal University of Rio de Janeiro State-UNIRIO, Rio de Janeiro, RJ, Brazil.
Viral Immunology Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
PLoS One. 2020 Feb 12;15(2):e0227763. doi: 10.1371/journal.pone.0227763. eCollection 2020.
Aging and chronic HIV infection are clinical conditions that share the states of inflammation and hypercoagulability. The life expectancy of the world population has increased in the last decades, bringing as complications the occurrence of diseases that undergoing metabolic, bone, cardiological, vascular and neurological alterations. HIV-infected patients experience these changes early and are living longer due to the success of antiretroviral therapy. The objectives of this study was to evaluate some changes in the plasma hemostatic profile of 115 HIV-reactive elderly individuals over 60 years old in the chronic phase of infection, and compare with 88 healthy uninfected elderly individuals. Plasma determinations of D-dimers, Fibrinogen, von Willebrand Factor, Antithrombin, Prothrombin Time, Activated Partial Thromboplastin Time, and platelet count were performed. In the HIV-reactive group, these variables were analyzed according to viral load, protease inhibitor use and CD4+ T lymphocyte values. After adjusted values for age and sex, the results showed higher levels of Antithrombin (103%; 88%, p = 0.0001) and Prothrombin Time activities (92.4%; 88.2%, p = 0.019) in the HIV group compared to the control group. We observed higher values of Fibrinogen in protease inhibitor users in both the male (p = 0.043) and female (p = 0.004) groups, and in the female HIV group with detected viral load (p = 0.015). The male HIV group with a CD4+ count> 400 cells / mm3 presented higher von Willebrand Factor values (p = 0.036). D-Dimers had higher values in the older age groups (p = 0.003; p = 0.042, respectively).
Our results suggest that the elderly with chronic HIV infection with few comorbidities had a better hemostatic profile than negative control group, reflecting the success of treatment. Protease inhibitor use and age punctually altered this profile.
衰老和慢性 HIV 感染是具有炎症和高凝状态的两种临床病症。过去几十年，世界人口的预期寿命有所增加，随之而来的是代谢、骨骼、心脏血管和神经等方面疾病的发病率上升。由于抗逆转录病毒治疗的成功，HIV 感染者很早就经历了这些变化，并且寿命更长。本研究的目的是评估 115 名年龄在 60 岁以上的慢性 HIV 感染老年患者的血浆止血谱的一些变化，并与 88 名健康未感染的老年患者进行比较。对血浆 D-二聚体、纤维蛋白原、血管性血友病因子、抗凝血酶、凝血酶原时间、活化部分凝血活酶时间和血小板计数进行了测定。在 HIV 反应组中，根据病毒载量、蛋白酶抑制剂的使用情况和 CD4+T 淋巴细胞值对这些变量进行了分析。对年龄和性别进行了调整后，结果显示与对照组相比，HIV 组的抗凝血酶（103%；88%，p=0.0001）和凝血酶原时间活性（92.4%；88.2%，p=0.019）水平更高。我们观察到在男性（p=0.043）和女性（p=0.004）蛋白酶抑制剂使用者中，以及在女性 HIV 组中检测到病毒载量时（p=0.015），纤维蛋白原水平更高。CD4+计数>400 个细胞/mm3的男性 HIV 组的血管性血友病因子值更高（p=0.036）。D-二聚体在年龄较大的年龄组中具有更高的值（p=0.003；p=0.042，分别）。
我们的结果表明，患有慢性 HIV 感染且合并症较少的老年患者的止血谱优于阴性对照组，这反映了治疗的成功。蛋白酶抑制剂的使用和年龄会及时改变这种状态。
