Pregnant patients with virologically suppressed human immunodeficiency virus (HIV) may be more likely to have impaired markers of fibrinolysis, according to research published in Thrombosis Research.
Approximately 1.3 million pregnant women worldwide are living with HIV, most commonly in Eastern and Southern Africa. While access to antiretroviral therapy (ART) has improved worldwide, patients in this population have increased risks of venous thromboembolism, placental vascular complications, and preterm delivery. ART has not, for example, been shown to markedly improve inflammation-related markers.
Previous research has suggested that there may be a link between markers related to coagulation and fibrinolysis and patient morbidity and mortality. D-dimer and plasminogen activator inhibitor-1 (PAI-1) levels have, for example, been linked with specific morbidities and all-cause mortality.
For this study, researchers evaluated whether d-dimer and PAI-1 levels, and thrombin antithrombin (TAT) complex concentrations — markers of fibrinolytic activity and coagulation, respectively — correlate with HIV viral load and outcomes among pregnant patients. Measurements were taken and outcomes were evaluated over each trimester.
Overall, 320 participants enrolled to this study; of 298 eligible participants, 109 were HIV negative, 109 were HIV positive with virological suppression, and 80 were HIV positive with viral load greater than 50 copies/mL. The mean age was 33 years and outcomes were noted for 277 (93%) patients.
In contrast with HIV-negative participants, patients with HIV, whether suppressed or with viral load greater than 50 copies/mL, had significantly higher d-dimer and PAI-1 levels during all 3 trimesters. Although d-dimer levels did significantly differ between the 2 HIV-positive groups in the second trimester only, no other statistical differences were noted in d-dimer levels or in PAI-1 levels in the HIV-positive groups.
TAT complex levels were, furthermore, higher among patients with virologically suppressed infection, compared with participants without HIV.
“Virological suppression was not associated with a significant reduction in d-dimer, PAI-1 and TAT complex levels, in each trimester, which suggests persistently impaired fibrinolytic and coagulation activity on long term ART,” the authors wrote in their report.
Schapkaitz E, Libhaber E, Jacobson BF, Toman M, Gerber A, Büller HR. Evaluation of markers of fibrinolysis and coagulation in pregnant women with human immunodeficiency virus. Thromb Res. 2022;217:1-8. doi:10.1016/j.thromres.2022.07.001