Evaluation of First-Line Coagulation Tests in Highly Active Antiretroviral Therapy (HAART) Naïve and Treated Group of HIV Infected Subjects

Ngwu Amauche Martina *

Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Enugu State University of Science and Technology, Enugu, Nigeria.

Ozoemena Chiadikobi Lawrence

Department of Human Anatomy, Faculty of Basic Medical Sciences, Enugu State University of Science and Technology, Enugu, Nigeria.

Umeh Okechukwu Elijah

Department of Medical Laboratory Science, Faculty of Health Sciences & Technology, Chukwuemeka Odumegwu Ojukwu University, Igbariam Campus, Anambra State, Nigeria.

Ugwu Ifeanyichukwu Basil

Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Enugu State University of Science and Technology, Enugu, Nigeria.

Ozoume Chibuike Innocent

Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Enugu State University of Science and Technology, Enugu, Nigeria.

*Author to whom correspondence should be addressed.


Background: Coagulation disorders are common in patients with Human Immunodeficiency virus (HIV). Coagulation abnormalities occur as a result of HIV-related thrombocytopenia, induced hepatotoxicity due to highly active antiretroviral therapy (HAART) that impairs liver function and diminishes the function and synthesis of coagulation factors. The aim of this study was to evaluate prothrombin time (PT), activated partial thromboplastin time (APTT), platelet count, mean platelet volume, plateletcrit and platelet distribution width in HAART-naïve HIV infected patients, HAART treated and HIV-seronegative controls.

Place and Duration of Study: Department of Haematology and antiretroviraltherapies (ART) clinic both of Enugu State University of Science and Technology Teaching Hospital, between March and June 2023.

Methodology: A total of 150 study participants, consisting of 50 HAART-naïve HIV-infected subjects, 50 HIV-infected subjects who were taking HAART, and 50 HIV-seronegative apparently healthy subjects, were included. Coagulation tests such as PT, APTT were determined by manual procedures. Platelet counts (PC), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW) were analyzed by Mindray/BC-5150 automated analyzer. The data were analyzed using SPSS version 21. Analysis of variance (ANOVA) and Pearson correlation analysis were used. P-Value < 0.05 was considered as statistically significant.

Results: Mild thrombocytopenia (100-<150 x 109/L) was found in 48% of HIV-infected subjects who were taking HAART, 76% mild thrombocytopenia and 24% moderate thrombocytopenia (50-<100 x109/L) was found in HAART-naïve HIV-infected subjects, but no thrombocytopenia was found in apparently healthy HIV-seronegative control. Prothrombin time and APTT were significantly higher, whereas PC and PDW was significantly lower in HIV-infected subjects (both who were taking HAART and HAART-naïve) than HIV-seronegative subjects (p<0.05). Prothrombin time and APTT were significantly higher, and PC was significantly lower in HAART-naïve HIV-infected subjects than HIV-infected subjects who were taking HAART. In Pearson correlation analysis, PT and APTT has shown a significant negative correlation with a PC in those taking HAART and HAART-naïve HIV-infected subjects, whereas significant positive correlation was found in HIV-seronegative subjects.

Conclusion: Prothrombin time and APTT significantly increased, whereas platelet count and PDW significantly decreased in HIV-infected subjects who were taking HAART and HAART-naïve. Basic coagulation parameters need to be monitored regularly in HIV-infected subjects in Enugu.

Keywords: Prothrombin time, activated partial thromboplastin time, platelet, HIV infected patients, HAART

How to Cite

Martina , N. A., Lawrence , O. C., Elijah , U. O., Basil , U. I., & Innocent , O. C. (2024). Evaluation of First-Line Coagulation Tests in Highly Active Antiretroviral Therapy (HAART) Naïve and Treated Group of HIV Infected Subjects. Journal of Advances in Medical and Pharmaceutical Sciences, 26(3), 1–8. https://doi.org/10.9734/jamps/2024/v26i3672


Download data is not yet available.


Global aids response–NACA Nigeria. (n.d.). Available: https://naca.gov.ng/wp-content/ uploads/2016/11/Nigeria_GARPR_2015_ Report.

Understanding fasttrack–UNAIDS. (n.d.) Available:https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrac k_en.pdf.

NACA National HIV Strategy for Adolescents and Young People – NACA Nigeria; 2016. Available:https://naca.gov.ng/national-hiv-strategy-adolescents-young-people/.

AwoyemiAbayomiAwofala and Olusegun Emmanuel Ogundele. HIV epidemiology in Nigeria. Saudi Journal of Biological Sciences. 2018 May;25(4):697–703.

Aboulafia DM, Mitsuyasu RT. Hematologic abnormalities in AIDS. Hematology-Oncology Clinics of North America. 1991; 5(2):195–214. DOI: 10.1016/s0889-8588(18)30436-2.

Funderburg NT. Markers of coagulation and inflammation often remain elevated in ART-treated HIV-infected patients. Current Opinion in HIV and AIDS.2014;9(1):80–86. DOI: 10.1097/coh.0000000000000019.

Jong E, Louw S, van Gorp EC, Meijers JC, ten Cate H, Jacobson BF. The effect of initiating combined antiretroviral therapy on endothelial cell activation and coagulation markers in South African HIV-infected individuals. Thrombosis & Haemostasis. 2010;104(12):1228–1234. DOI: 10.1160/TH10-04-0233.

Calza L, Pocaterra D, Pavoni M, Colangeli V, Manfredi R, Verucchi G, Chiodo F, Cantu M, Pariali M. Plasma levels of VCAM-1, ICAM-1, E-Selectin, and P-Selectin in 99 HIV-positive patients versus 51 HIV-negative healthy controls. Journal of Acquired Immune Deficiency Syndromes. 2009;50(4):430–432. DOI: 10.1097/qai.0b013e31819a292c.

Schved JF, Gris JC, Arnaud A, Martinez P, Sanchez N, Wautier JL, C SarlatC. Von willebrand factor antigen, tissue-type plasminogen activator antigen, and risk of death in human immunodeficiency virus 1-related clinical disease: independent prognostic relevance of tissue-type plasminogen activator. The Journal of Laboratory and Clinical Medicine. 1992; 120(3):411–419.

Aukrust P, Bjørnsen S, Lunden B, Otterdal K, Ng EC, Ameln W, Ueland T, Müller F, Solum NO, Brosstad F, Frøland SS. Persistently elevated levels of von Willebrand factor antigen in HIV infection. Thrombosis & Haemostasis. 2000;84(8):1 83–187.

Oguntibeju OO, Van Den Heever WMJ, Van Schalkwyk FE. Effect of a liquid nutritional supplement on viral load and haematological parameters in HIV-positive/AIDS patients. British Journal of Biomedical Science. 2006;63(3):134–139. DOI: 10.1080/09674845.2006.11732733.

Evans RH, Scadden DT. Haematological aspects of HIV infection. Best Practice & Research Clinical Haematology. 2000; 13(2):215–230. DOI:10.1053/beha.1999.0069.

Torre D, Pugliese A. Platelets and HIV-1 infection: old and new aspects. Current HIV Research. 2008;6(5):411–418. DOI: 10.2174/157016208785861140.

López M, San Román J, Estrada V, Vispo E, Blanco F, Soriano V. Endothelial dysfunction in HIV infection--the role of circulating endothelial cells, microparticles, endothelial progenitor cells and macrophages. AIDS Reviews. 2012;14(4): 223–230.

Solages A, Vita JA, Thornton DJ, Murray J, Heeren T, Craven DE, Horsburgh CR. Endothelial function in HIV-infected persons. Clinical Infectious Diseases. 2006;42(9):1325–1332. DOI:10.1086/503261.

Neuhaus J, Jacobs DR, Jr Baker JV, Calmy A, Duprez D, Rosa AL, Kuller LH, Pett SL, Ristola M, Ross MJ, Shlipak M, Tracy R, Neaton JD Markers of inflammation, coagulation, and renal function are elevated in adults with HIV infection. Journal of Infectious Diseases. 2010;201(12):1788–1795. DOI:10.1086/652749.

Majluf-Cruz A. Changes in blood coagulation in HIV infection. Revista de InvestigacionClinica; Organo del Hospital de Enfermedades de la Nutricion. 1997; 49(1):51–66.

Quick AJ, Stanley-Brown M, Bancroft F. A study of the coagulation defect in haemophilia and in jaundice. American Journal of Medical Sciences. 1935;190: 501-502.

Cheesbrough M. District laboratory practice in tropical countries. Low price editions, part 2000;2:344-345.

Oloro OH, Oke TO, Obeagu EI. Evaluation of coagulation profile patients with pulmonary tuberculosis and human immunodeficiency virus in Owo, Ondo State, Nigeria. Madonna University journal of Medicine and Health Sciences. 2022; 2(3):110-9.

Chamroonkul N, Bansal MB. HIV and the liver. Nature Reviews Gastroenterology & Hepatology. 2019;16(1):1-2.

Franzetti M, Adorni F, Oreni L, Bogaart LV, Resnati C, Milazzo L, Antinori S, Galli M, Ridolfo A. L. Changes in the incidence of severe thrombocytopenia and its predisposing conditions in HIV-infected patients since the introduction of highly active antiretroviral therapy. J Acquir Immune DeficSyndr. 2014;67(5):493-498.

Getawa S, Adane T. Coagulation parameters in human immunodeficiency virus infected patients: a systematic review and meta-analysis. AIDS Research and Treatment; 2022. DOI: 10.1155/2022/6782595

Abdollahi A, Shoar N, Shoar S, Rasoulinejad M. Extrinsic and intrinsic coagulation pathway, fibrinogen serum level and platelet count in HIV positive patients. Acta MedicaIranica. 2013;51: 472–476.

Ifeanyichukwu M, Sylvester NI, Aja OJ, Okeke C. Activated partial thromboplastin time, prothrombin time, thrombin time and platelet count study in HIV seropositive subjects at Nnamdi Azikiwe teaching hospital Nnewi. Translational Biomedicine. 2016;7:63–67

Seyoum M, Enawgaw B, Getaneh Z, Engidaye G, Asrie F, Melku M. Basic coagulation parameters among human immunodeficiency virus-infected adults in Gondar, Northwest Ethiopia: A comparative cross-sectional study. BioMed Research International. 2018;2018:9. DOI:10.1155/2018/5320827.5320827.

Parinitha S, Kulkarni M. Haematological changes in HIV infection with correlation to CD4 cell count . Australas Med J. 2012;5(3):157–62.

Munyazesa E, Emile I, Mutimura E, Hoover DR, Shi Q, McGinn AP, Musiime S, Muhairwe F, Rutagengwa A, Dusingize JC, Anastos K. Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: A cross-sectional study. BMJ Open. 2012;2(6): e001600.

Wondimeneh Y, Muluye D, Ferede G. Prevalence and associated factors of thrombocytopenia among HAART-naive HIV-positive patients at Gondar University Hospital, northwest Ethiopia. BMC Res Notes. 2014;7:5. Available:https://doi.org/10.1186/1756-0500-7-5

Okoroiwu IL, Amadi U, Obeagu EI, Anode AU, Euphemia I. The correlation of values of Cd4 count, platelet, Pt, Aptt, fibrinogen and factor VIII concentrations among HIV positive patients in FMC Owerri. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2014;13 (9):94-101.