Thrombophilia in Human Immunodeficiency Virus—Infected Patients with Osteonecrosis: Is There a Real Connection? The First Case-Control Study

Larrañaga, Gabriela de; Bottaro, Edgardo; Martinuzzo, Marta; Figueroa, Raúl H.; Varela, Maria L.; Wingeyer, Silvia Perés; Forastiero, Ricardo; Adamczuk, Yolanda; Corti, Marcelo; Puga, L.; Benetucci, Jorge

doi:10.1177/1076029607310217

Cited by 13 publications

(16 citation statements)

References 41 publications

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“…4,6,9,11 Our data for steroid exposure are broadly comparable to that of Fessel et al, 13 in terms of aggregate corticosteroid dose given per month prior to AVN diagnosis and the dose given in the year prior to AVN diagnosis. In addition, the proportion who had received corticosteroids in the year prior to AVN diagnosis was 5/15 (33%) in our data compared with (3/12) 25% for Fessel et al Suggestions of how steroid exposure mediates cell death include increased apoptosis through activation of free radicals and inflammatory mediators, 4 increased intraosseous pressure due to fat infiltration of bone marrow causing obstruction in small blood vessels 11 or fat embolization in vessels through secondary hyperlipidaemia.…”

Section: Discussionsupporting

confidence: 79%

“…Established risk factors for AVN in individuals without HIV (such as alcohol abuse, corticosteroid use, coagulopathies) may be more prevalent in those with HIV. [4][5][6][7][8][9][10][11] Moreover, it has been suggested that HIV infection itself and antiretroviral therapy (ART), particularly protease inhibitors (PIs), 12 may increase AVN risk. This study investigates the association of AVN in HIV-positive individuals with possible risk factors including ART.…”

Section: Introductionmentioning

confidence: 99%

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Avascular necrosis in HIV patients: a case–control study

et al. 2013

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This study investigates the association of avascular necrosis (AVN) in human immunodeficiency virus (HIV)-positive individuals with possible risk factors, including antiretroviral therapy. Clinic records of all AVN cases diagnosed up to July 2009 in HIV-positive patients attending North Middlesex Hospital, London, UK were retrospectively reviewed. For each case, one control was randomly selected, matched for gender, age, nadir CD4 count and date of HIV diagnosis. Of 15 symptomatic AVN cases identified, eight were in women. Univariate analysis demonstrated significant associations between AVN and a history of systemic steroid use (p = 0.004) and cumulative exposure to protease inhibitor (p = 0.03). Physicians should be aware of the risk of AVN with steroid use, the importance of early diagnosis and avoidance of other risk factors in order to prevent further joint involvement if possible.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Avascular necrosis in HIV patients: a case–control study

et al. 2013

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“…In the past few years, many reports have documented an increased risk of venous and arterial thrombosis in HIVinfected patients [10][11][12]. Our observations during clinical practice indicate that female patients with HIV infection are more prone to venous and arterial thrombosis than male patients.…”

Section: Introductionsupporting

confidence: 57%

Factor VIII concentration is greater in female than male patients with HIV infection

et al. 2010

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The purpose of the present study was comparing plasma markers of coagulation between men and women in both HIV-infected patients and controls. Fifty-eight HIV-infected patients and 58 healthy participants who were individually matched with patients in age and sex were included in the study. We simultaneously collected blood samples for CD4+ T cell count, CD8+ T cell count, platelets count, hemoglobin, partial thromboplastin time (PTT), prothrombin time, international normalized ratio and blood type measurements. We used fresh plasma of the studied population to measure factor VIII, fibrinogen, antithrombin, protein C and protein S levels. CD4+ T cell count, CD8+ T cell count, platelet count, PTT, plasma fibrinogen, antithrombin, protein C and protein S levels were significantly lower, and plasma factor VIII levels were significantly higher in HIV patients. Factor VIII levels were significantly higher in HIV-infected women than HIV-infected men [200 (181-258) vs. 170 (150-194), p < 0.05]. This difference remained significant [219.7 (195.8-248.7) vs. 158 (136.5-180.3), p < 0.001] after multiple adjustments for age, CD8+ and CD4+ T cell count, using general linear model. Plasma factor VIII concentration was significantly higher in HIV-infected women after stratifying the patients into O, B, A and AB blood groups when there was not any gender difference in controls. We suggest that there is a sexual dimorphism in factor VIII concentration in HIV-infected patients.

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“…In the past few years, an increased risk of venous and arterial thrombosis in HIV-infected patients has been documented [10][11][12]. This is partly correlated with an increased serum level of antiphospholipid and anticardiolipin antibodies in these patients [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Serum concentrations of antiphospholipid and anticardiolipin antibodies are higher in HIV-infected women

Abdollahi

Morteza

2011

Rheumatol Int

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Manifestations of viral infections like human immune deficiency virus (HIV) differ between women and men. There are some reports due to a higher risk of thrombosis due to antiphospholipid syndrome in HIV-infected women compared with men. The purpose of this study was demonstrating the impact of gender on serum concentration of antiphospholipid and anticardiolipin antibodies in HIV-infected patients. A total of 58 HIV-infected patients and 58 age, sex-matched healthy adults were enrolled. We measured platelets count, hemoglobin, partial thromboplastin time (PTT); prothrombin time (PT), international normalized ratio (INR), antiphospholipid IgG/IgM and anticardiolipin IgG/IgM serotypes in our studied population. Age, male-to-female ratio, hemoglobin level, PT, INR, antiphospholipid IgM isotype, anticardiolipin IgM and IgG isotypes levels were not significantly different between HIV-infected patients and healthy individuals, when CD4+ T-cell count, CD8+ T-cell count, platelet count, and PTT were significantly lower, and antiphospholipid IgG isotype levels was significantly higher in HIV patients. Antiphospholipid IgG isotypes (3.2 [2.8-4.2] vs. 2.5 [2.3-3.1]; P < 0.001) and anticardiolipin IgG isotypes (2.2 [1.9-2.7] vs. 1.4 [1.4-1.9]; P < 0.001) were significantly higher in HIV-infected women than in HIV-infected men. Antiphospholipid IgG/IgM and anticardiolipin IgG/IgM were significantly correlated in HIV-infected men and women when they did not had any correlation in controls. We suggest that HIV infection accelerate thrombosis in women more profoundly than in men, as a result of differences in disease progression and response to therapy in these patients.

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Thrombophilia in Human Immunodeficiency Virus—Infected Patients with Osteonecrosis: Is There a Real Connection? The First Case-Control Study

Cited by 13 publications

References 41 publications

Avascular necrosis in HIV patients: a case–control study

Avascular necrosis in HIV patients: a case–control study

Factor VIII concentration is greater in female than male patients with HIV infection

Serum concentrations of antiphospholipid and anticardiolipin antibodies are higher in HIV-infected women

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