HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation.

Jason V. Baker, Kathleen Brummel-Ziedins, Jacqueline Neuhaus, Daniel Duprez, Nathan W Cummins, David Dalmau, Jack DeHovitz, Clara Lehmann, Ann Sullivan, Ian Woolley, Lewis Kuller, James D. Neaton, Russell P. Tracy, SMART Study Team INSIGHT SMART Study Team

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

HIV infection leads to activation of coagulation, which may increase the risk for atherosclerosis and venous thromboembolic disease. We hypothesized that HIV replication increases coagulation potentially through alterations in extrinsic pathway factors. Extrinsic pathway factors were measured among a subset of HIV participants from the Strategies for Management of Anti-Retroviral Therapy (SMART) trial. Thrombin generation was estimated using validated computational modeling based on factor composition. We characterized the effect of antiretroviral therapy (ART) treatment versus the untreated state (HIV replication) via 3 separate analyses: (1) a cross-sectional comparison of those on and off ART (n=717); (2) a randomized comparison of deferring versus starting ART (n=217); and (3) a randomized comparison of stopping versus continuing ART (n=500). Compared with viral suppression, HIV replication consistently showed short-term increases in some procoagulants (eg, 15% to 23% higher FVIII; P<0.001) and decreases in key anticoagulants (eg, 5% to 9% lower antithrombin [AT] and 6% to 10% lower protein C; P<0.01). The net effect of HIV replication was to increase coagulation potential (eg, 24% to 48% greater thrombin generation from computational models; P<0.01 for all). The pattern of changes from HIV replication was reversed with ART treatment and consistent across all 3 independent comparisons. HIV replication leads to complex changes in extrinsic pathway factors, with the net effect of increasing coagulation potential to a degree that may be clinically relevant. The key influence of changes in FVIII and AT suggests that HIV-related coagulation abnormalities may involve changes in hepatocyte function in the context of systemic inflammation.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume2
Issue number4
StatePublished - Aug 2013

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Blood Coagulation Factors
Thrombin
HIV
Antithrombins
Therapeutics
Protein C
Anticoagulants
HIV Infections
Hepatocytes
Atherosclerosis
Inflammation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Baker, J. V., Brummel-Ziedins, K., Neuhaus, J., Duprez, D., Cummins, N. W., Dalmau, D., ... INSIGHT SMART Study Team, SMART. S. T. (2013). HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation. Journal of the American Heart Association, 2(4).

HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation. / Baker, Jason V.; Brummel-Ziedins, Kathleen; Neuhaus, Jacqueline; Duprez, Daniel; Cummins, Nathan W; Dalmau, David; DeHovitz, Jack; Lehmann, Clara; Sullivan, Ann; Woolley, Ian; Kuller, Lewis; Neaton, James D.; Tracy, Russell P.; INSIGHT SMART Study Team, SMART Study Team.

In: Journal of the American Heart Association, Vol. 2, No. 4, 08.2013.

Research output: Contribution to journalArticle

Baker, JV, Brummel-Ziedins, K, Neuhaus, J, Duprez, D, Cummins, NW, Dalmau, D, DeHovitz, J, Lehmann, C, Sullivan, A, Woolley, I, Kuller, L, Neaton, JD, Tracy, RP & INSIGHT SMART Study Team, SMARTST 2013, 'HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation.', Journal of the American Heart Association, vol. 2, no. 4.
Baker, Jason V. ; Brummel-Ziedins, Kathleen ; Neuhaus, Jacqueline ; Duprez, Daniel ; Cummins, Nathan W ; Dalmau, David ; DeHovitz, Jack ; Lehmann, Clara ; Sullivan, Ann ; Woolley, Ian ; Kuller, Lewis ; Neaton, James D. ; Tracy, Russell P. ; INSIGHT SMART Study Team, SMART Study Team. / HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation. In: Journal of the American Heart Association. 2013 ; Vol. 2, No. 4.
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