DERANGEMENT IN PROTEIN S AND C4b BINDING PROTEIN LEVELS AS AN ACQUIRED THROMBOPHILIA IN HIV INFECTED ADULTS ATTENDING APIN CLINIC, LUTH LAGOS

Abstract

INTRODUCTION

HIV infected patients have an increased risk of developing thrombotic disorders. The
derangement in the serum levels of free protein S, C4b-binding protein beta and the Euglobin
clot lysis test were studied as a possible explanation for the increased risk of thrombosis and the
effect of highly active anti retroviral therapy (HAART) on these parameters.
METHOD
The study population consisted of HIV infected adults who are on treatment with HAART and
have achieved virological suppression, HIV infected adults not yet on treatment with HAART
and apparently healthy adults who tested negative to HIV antibody screening as control. Blood
samples were collected and serum levels of free protein S, C4b-binding protein beta and the
Euglobin clot lysis time were determined.
RESULTS
There is a significant decrease in serum free protein S level in HIV-infected adults who are not
on HAART (75.7%±27.3) and those that are on HAART (86.92% ± 25.79) compared to the
control group (94.9%±7.9),(p=0.000). Protein S deficiency is found in 20.1% of HIV-infected
subjects. The deficiency is more prevalent among those that not on HAART (25.9%) compared
to those that are on HAART (14.8%), (p=0.000). Protein S deficiency is more prevalent among
HIV infected subjects with CD4+cells counts less than 350cells/µl (32.7%) compared to the HIV
infected subjects with CD4+cells count greater than 350cells/µl (11.4%), (p=0.005).C4b-binding
protein beta is significantly higher in HIV infected subjects not on HAART (85.1mg/dl±52.6)
compared to those on HAART (43.8mg/dl±42.4) and the control group
(22.4mg/dl±18.4).(p=0.000). The difference in the mean between the HIV infected subjects on
HAART and those not yet on HAART is statistically significant (p=0.000). C4b-binding protein
beta is significantly higher in HIV infected subjects with CD4+cells count less than 350 cells/µl
(p=0.008).Protein S deficiency is more prevalent among the subjects with elevated C4b-binding
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Protein beta (p=0.001).Euglogin clot lysis time (ECLT) is significantly longer in HIV infected
subjects not on HAARTT compared to those on HAART.(p=0.002)
CONCLUSION
HIV infection is associated with derangement in the levels of C4b Binding Protein beta and
serum free Protein S. This may be responsible for the increase risk of thrombosis associated with
HIV infection. The risk of thrombosis is higher with CD4+ cells count less than 350 cells/µl and
reduced with the use HAART.

DERANGEMENT IN PROTEIN S AND C4b BINDING PROTEIN LEVELS AS AN ACQUIRED THROMBOPHILIA IN HIV INFECTED ADULTS ATTENDING APIN CLINIC, LUTH LAGOS