Changes in D-Dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya

Abstract

Background Increased coagulation biomarkers are associated with poor outcomes among people living with HIV(PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to six months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at six months is reported on the log10 scale and as percentage change from baseline. Results Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29–43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600 − 399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (> 500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7-926.6) (log baseline D-dimer: 2.7, IQR: 2.5-3.0). Higher baseline D-dimer was significantly associated with higher viral load (p < 0.0001), female sex (p = 0.02) and tuberculosis (p=-0.02). After six months on ART, 518 (84.8%) PLHIV had achieved viral load < 1,000 copies/mL and median D-dimer was 390.0 (IQR: 236.6-656.9) (log D-dimer: 2.6, IQR: 2.4–2.8). Mean change in log D-dimer from baseline to six months was − 0.12 (95%CI -0.15, − 0.09) (p < 0.0001) indicating at 31.3% decline (95%CI -40.0, -23.0) in D-dimer levels over the first six months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation

von Willebrand factor propeptide‐to‐antigen ratio in HIV‐infected pregnancy: Evidence of endothelial activation

“…Similarly, persistent endothelial activation has been reported in non‐pregnant HIV‐infected populations on long‐term ART 29,30 . In particular, large observational studies have illustrated a decline in D‐dimer levels with virological suppression 31‐34 . However, D‐dimer levels remained significantly elevated compared to HIV‐negative controls 13,35 and pre‐HIV levels 36,37 .…”

“…29,30 In particular, large observational studies have illustrated a decline in D-dimer levels with virological suppression. [31][32][33][34] However, D-dimer levels remained significantly elevated compared to HIV-negative controls 13,35 and pre-HIV levels. 36,37 Several mechanisms for ongoing endothelial activation on suppressive long-term ART have been proposed.…”