ASSESSMENT OF SOME HAEMOSTATIC PARAMETERS IN TREATMENT-NAÏVE HIV SEROPOSITIVE INDIVIDUALS ATTENDING NASARA TREATMENT AND CARE CENTRE OF AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH) ZARIA

Abstract

Human immunodeficiency virus infection is a global health problem characterized by immune paresis resulting in a number of opportunistic infections, malignancies and haematological complications, of which haemostatic abnormalities are now emerging manifestations of the infection. This study was carried out on treatment-naive HIV-infected individuals in Zaria, Nigeria, with a view to determining some haemostatic parameters among this group of individuals. Some 72 individuals who were treatment-naive HIV seropositive and Western blot confirmed (subjects), together with 50 HIV seronegative individuals (controls) without risk factors for haemostatic abnormalities were recruited into the study. A structured questionnaire was designed to obtain relevant demographic data and information on possible risk factors for haemostatic abnormalities. Blood samples for haematological indices were collected before 12 noon on the day of test, 5ml of venous blood into EDTA bottle, and used to obtain full blood count (FBC), CD4+ cell counts and viral load (VL). Another 4.5ml of venous blood was collected into a test bottle containing 0.5ml of 3.2% sodium citrate for prothrombin time (PT), expressed as international normalized ratio (INR),activated partial thromboplastin time (APTT), fibrin degradation products (FDPs) and D-dimer. The mean age of the controls was 31.7 ± 8.3 year, while the subjects had a mean age of 34.3 ± 7.2 years (p>0.05). The controls were made up of 26 males and 24 females, while the subjects comprised of 29 males and 43 females. The mean PCV (42.5 ± 4.5% vs. 36.9 ±6.9%), WBC count (5.5 ± 1.2 x 109 /l vs. 4.8 ± 1.8 x109 /l) and CD4+ cell count (816.1 ± 194.7 cells/mm3 vs. 326.5 ± 168.2 cells/mm3) were significantly higher in the control than the subjects, p<0.05 respectively. The mean VL for the subjects was high 210,306.3 ± 201,099 copies/ml. The platelets count of the subjects (265 ± 77.8 x 109/l) was higher than the controls (238.3± 60.0 x 109/l) (p<0.05). There was no significant difference in the absolute lymphocyte count (ALC) of the two groups (p>0.05). A positive correlation was obtained between the PCV and CD4+ cell count of the subjects (r = 0.36, p < 0.05). The mean INRs (1.0 ± 0.2 vs. 1.6 ± 0.7) and mean platelets counts (238.3 ± 60.0 x109 /l vs. 265 ±77.8×109 /l) were significantly higher in the subjects than the controls p < 0.05. There were 47(65.3%) participants among the subjects with INR above the cut-off limit of 0.9-1.3. There was a negative correlation between the INR and CD4+ cell count of the subjects (r = -0.32, p<0.05) The mean APTT for the subjects was 42.8 ±

5.0 sec and was significantly higher than those of the controls (38.7 ± 3.8 sec) p < 0.05, twenty subjects (27.8%) had prolonged APTT. Twenty six (36.1%) participants among the subjects had elevated FDPs and D-dimer, while 46 (63.9%) had normal values. Semiquantitative analyses of samples with elevated values gave FDPs and D-dimer values of 27.7 ± 9.9µg/ml and 8.9 ± 2.6µg/ml-FEU respectively. In conclusion, HIV infection predisposes to prolongation of APTT, a high INR and elevated levels of FDPs and D-dimer. There was an inverse correlation between INR and CD4+ cell count. It could be recommended that routine assessment of haemostatic parameters be included in the investigation of treatment-naive HIV-infected individuals, and they should be follow-up upon commencement of anti-retroviral therapy.

ASSESSMENT OF SOME HAEMOSTATIC PARAMETERS IN TREATMENT-NAÏVE HIV SEROPOSITIVE INDIVIDUALS ATTENDING NASARA TREATMENT AND CARE CENTRE OF AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH) ZARIA