Fibrinolytic changes in pregnant women on highly active antiretroviral therapy

Objectives:

To report on the changes in fibrinolytic activity in human immunodeficiency virus (HIV) infected pregnant women who are undergoing highly active antiretroviral therapy (HAART).

Methods:

Blood was collected from 50 HIV positive women on HAART (test subjects), and 50 HIV positive women not on HAART (controls). These women were attending the prevention of mother to child clinic (PMTCT) of the University of Benin Teaching Hospital, Benin City, Nigeria from January to June 2014. Standard manual techniques were used to estimate plasma fibrinogen concentration (PFC), euglobulin lysis time (ELT), packed cell volume (PCV), and plasma viscosity (PV).

Results:

The mean ± standard error of mean (SEM) of PFC was 4.02±0.13g/l and ELT from the test subjects was 378±15 mins was significantly higher (p<0.05) compared with the control subjects (PFC 3.46±0.12g/l and ELT 267±9.0mins). The PCV or hematocrit values in the test subject was 29.1±0.38%, which was significantly lower (p<0.05) compared with the control subject (31.3±0.43%). The PV in the test subject was 1.76±0.02 mPa/s, while the control subjects was higher (1.73±0.02 mPa/s). This increase was not statistically significant (p>0.05). There were differences in the various parameters investigated when the various trimesters were compared. These differences did not, however, follow a particular pattern.

Conclusion:

Highly active antiretroviral therapy can cause changes in fibrinolytic activity that may predispose pregnant women to hyperfibrinogenemia and anemia.During pregnancy the physiology of a woman is temporary changed to accommodate the newly developing fetus.1 Conception occurs during ovulation, which is approximately on the fourteenth day of a regular menstrual cycle. In conception, the ovum is fertilized in the fallopian tube and becomes a zygote, which is then carried into the uterus. There are changes in the coagulation and fibrinolytic system during pregnancy and knowledge of these physiological changes characterized by hemodilution, changes in the concentration of one or more plasma protein fractions, and reduced fibrinolytic activity is necessary to manage 2 of the more serious problems in pregnancy; namely hemorrhage and thrombo-embolic diseases.2 Increased levels of plasma proteins and reduced fibrinolytic activity have been reported in pregnancy,3 while prolonged euglobulin lysis time (ELT) and increased levels of fibrinogen have also been observed in pregnancy.4 While numerous studies have examined optimal methods for prevention of mother to child transmission of human immunodeficiency virus (HIV) and subsequent response to HAART,5 as well as the impact of pregnancy on outcomes of HIV in the pre-HAART era,6 little is known of the impact of pregnancy on response to HAART in Africa. There are several biologically plausible mechanisms that might alter efficacy of several antiretroviral agents including changes in enzyme activity and beta-estradiol levels, pregnancy-related changes in blood volume and body mass index, and factors which may compromise adherence to HAART ante and post-partum, such as nausea/vomiting, labor-associated morbidity, or responsibility for a new infant.7 Human immunodeficiency virus infected patients have been reported to be at risk of cardiovascular diseases, (CVD) mostly due to the use of antiretroviral agents.8,9 Protease inhibitors have been mostly implicated.10 All these are also connected to fat redistribution dyslipidemia and insulin resistance observed in HIV patients;11,12 thus, this study aims to report on the changes in fibrinolytic activity in HIV infected pregnant women who are undergoing HAART.