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Analysis of the Coagulation Profile in Children with HIV Infection–Effect of Disease and Anti Retroviral Therapy


The pathogenesis of hypercoagulability in HIV infection is multifactorial and usually more than one factor is responsible for a thromboembolic episode. The present study was conducted to evaluate the effect of HIV infection and antiretroviral therapy on various coagulation parameters in paediatric patients. Forty two newly diagnosed paediatric patients with HIV infection who were enrolled at the Anti-Retro viral Therapy (ART) centre of Kalawati Saran Children’s Hospital were included in the study. The patients were grouped into 4 clinical stages according to the WHO clinical staging of HIV disease. Coagulation tests [PT, aPTT, fibrinogen, D-Dimer and coagulation inhibitors i.e. Protein C (PC), Protein S (PS) and antithrombin III (AT III), Lupus anticoagulant (LA) and Anti phospholipid antibody (APLA)] were performed in all the patients at the time of diagnosis and repeated after 6 months. All the patients were started on antiretroviral therapy within 2 months of their diagnosis. At the time of diagnosis, prolonged PT and aPTT were observed in 30.9% and 23% of the cases respectively. Hyperfibinogenemia was seen in 11.9% of patients. D-Dimer was raised in 83.3% of patients. PS, PC & AT activities were reduced in 90.4%, 42.8% & 11.9% of cases respectively. A reduction in the PC and AT activity was seen from clinical stage 1 to 4, but the change was not statistically significant. On follow up after 6 months, a statistically significant reduction in the level of fibrinogen and D-Dimer was seen. Even though there was improvement in the activity of all the coagulation inhibitor after 6 months, statistically significant improvement was seen only for PS. The current study shows that HIV produces a hypercoagulable state in children. Raised d-dimer level and deficiency of natural anticoagulants contribute to the thrombophilic state.

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  1. Fauci AS, Lane HC. (2012) Human Immunodeficiency Virus Disease: AIDS and related disorders. In: Braunwalde kasper DL, Hauses SL, Longo DL, Jame son JL et al (eds) Harrisons principles of internal medicine, 18th edn. MacGraw Hill, New York. pp.1506,1519,1557

  2. Mu H, Chai H, Lin PH, Yao Q, Chen C (2007) Current update on hiv-associated vascular disease and endothelial dysfunction. World J Surg 31:632–643

    Article  Google Scholar 

  3. Klein SK, Slim EJ, de Kruif MD, Keller TT, ten Cate H, van Gorp EC et al (2005) Is chronic HIV infection associated with venous thrombotic disease? A Syst Review Neth J Med 63:129–136

    CAS  Google Scholar 

  4. Bibas M, Biava G, Antinori A (2011) HIV-associated venous thromboembolism. Mediterr J Hematol Infect Dis 3:e2011030

    Article  Google Scholar 

  5. Sullivan PS, Dworkin MS, Jones JL, Hopper WC (2000) Epidemiology of thrombosis in HIV-infected individuals. AIDS 3:321–324

    Article  Google Scholar 

  6. Mujlaf- Cruz A, Silva EM, Sanchez BR, Montiel MG, Trevino PS, Santoscoy GM et al (2004) Venous thrombosis among patients with AIDS. Clin Appl Thromb Hemost 10:19–25

    Article  Google Scholar 

  7. Lijfering WM, Ten Kate MK, Sprenger HG, Van der Meer J (2006) Absolute risk of venous and arterial thrombosis in HIV-infected patients and effects of combination antiretroviral therapy. J Thromb Haemost 4:1928–1930

    CAS  Article  Google Scholar 

  8. George SL, Swindells S, Knudson R, Stapleton JT (1999) Unexplained thrombosis on HIV infected patients recieving protease inhibitors: report of seven cases. Am J Med 107:624–626

    CAS  Article  Google Scholar 

  9. Philips AN, Carr A, Neuhaus L, Vignegarwala F, Prineas R, Burman WJ et al (2008) Interruption of antiretroviral therapy and risk of cardiovascular disease in patients with HIV-1 infection: exploratory analyses from the SMART trial. Antivir Ther 13:177–187

    Google Scholar 

  10. Crum-Cianflone NF, Weekes J, Baravo M (2008) Thromboses among HIV infected patients during the highly active antiretroviral therapy era. AIDS Patient Care STDS 22:771–778

    Article  Google Scholar 

  11. World health organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV related disease in adults and children; 2007.

  12. Omoregie R, Osakue SI, Ihemeje V, Omokaro EU, Ogefere HO (2009) Correlation of CD4 count with platelet count, prothrombin time and activated partial thromboplastin time among HIV patients in Benin City. Nigeria West Indian Med J 58:437–440

    CAS  PubMed  Google Scholar 

  13. Ifeanayi OE, Obeagu Uzoma G, Ijeoma O, Chioma UI (2015) The value of activated partial thromboplastin (APTT) among HIV positive patients in FMC Owerri. Int J Curr Res Acad Rev 3:139–44

    Google Scholar 

  14. Stahl CP, Wideman CS, Spira TJ, Haff EC, Hixon GJ, Evatt BL (1993) Protein S deficiency in men with long term human immunodeficiency virus infection. Blood 81:1801–1807

    CAS  Article  Google Scholar 

  15. Pontrelli G, Martino AM, Tchidjou HK, Citton R, Mora N, Rava L et al (2010) HIV is associated with thrombophila and high D-dimer in children and adolescents. AIDS 24:1145–1151

    CAS  Article  Google Scholar 

  16. Michael CJ, Bruce JD, David MA (2004) Thrombotic complications in patients infected HIV in the era of highly active antiretroviral therapy: a case series. Clin Infect Dis 39:1214–1222

    Article  Google Scholar 

  17. Erbe M, Rickerts V, Bauersachs RM, Lindhoff- LE (2003) Acquired protein C and protein S deficiency in HIV infected patients. Clin Appl Thromb hemost 9:325–331

    CAS  Article  Google Scholar 

  18. Sugerman RW, Church JA, Goldsmith TC, Ens GE (1996) Acquired protein S deficiency in children infected with human immuno deficiency virus. Pediatr Infect Dis J 15:106–111

    CAS  Article  Google Scholar 

  19. Bissuel F, Verruyer M, Causse X, Dechavanne M, Trepo C (1992) Acquired protein S deficiency: correlation with advanced disease in HIV-1 infected patients. J Acquir Immune Defic Syndr 5:484–489

    CAS  Article  Google Scholar 

  20. Hassel KL, Kressin DC, Neumann A, Ellison R, Marlar RA (1994) Correlation of antiphospholipid antibodies and proteins deficiency with thrombosis in HIV infected men. Blood Coagul Fibrinolysis 5:455–462

    Google Scholar 

  21. Nasir IA, Owalagba A, Ahmad AE, Barma MM, Musa PO, Bakare M et al (2016) Effects of first line anti-retroviral therapy on blood coagulation parameters on HIV infected patients attending a tertiary hospital at Abuja. Niger Malays J Pathol 38:103–109

    CAS  Google Scholar 

  22. Wolf K, Tsakiris DA, Weber R, Erb P, Battegay M (2002) Antiretroviral therapy reduces markers of endothelial and coagulation activation in patients infected with human immunodeficiency virus type 1. J Infect Dis 185:456–462

    CAS  Article  Google Scholar 

  23. Galrao L, Brites C, Atta ML, Atta A, Lima I, Gonzalez F et al (2007) Antiphospholipid antibodies in HIV positive patients. Clin Rheumatol 26:1825–1830

    Article  Google Scholar 

  24. Palomo I, Alarcon M, Sepulveda C, Periera J, Espinola R, Pierangeli S (2003) Prevalence of antiphospholipid and antiplatelet antibodies in human immunodeficiency virus (HIV)-infected Chilean patients. J Clin Lab Anal 17:209–215

    CAS  Article  Google Scholar 

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Authors and Affiliations



Dr Priya Thomas: iterature search, data acquisition, data analysis, manuscript preparation, statistical analysis, Dr Sunita Sharma: Concepts, design, manuscript editing, manuscript review, “Guarantor”, Dr Jagdish Chandra: Definition of intellectual content, clinical studies, Anita Nangia: Data analysis, Shivali Sehgal: Literature search, data analysis, manuscript preparation, manuscript editing.

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Correspondence to Shivali Sehgal.

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The approval was obtained from the ethical committee of the college. The procedures used in the study adhere to the tenets of the Declaration of Helsinki.

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Thomas, P., Sharma, S., Chandra, J. et al. Analysis of the Coagulation Profile in Children with HIV Infection–Effect of Disease and Anti Retroviral Therapy. Indian J Hematol Blood Transfus 38, 132–137 (2022).

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  • Coagulation profile
  • Children
  • HIV
  • Anti-retroviral therapy