Targeting thrombogenicity and inflammation in chronic HIV infection

• Published in: Science advances Vol. 5; no. 6; p. eaav5463
• Main Authors: O'Brien, Meagan P, Zafar, M Urooj, Rodriguez, Jose C, Okoroafor, Ibeawuchi, Heyison, Alex, Cavanagh, Karen, Rodriguez-Caprio, Gabriela, Weinberg, Alan, Escolar, Gines, Aberg, Judith A, Badimon, Juan J
• Format: Journal Article
• Language: English
• Published: United States American Association for the Advancement of Science 01.06.2019
• Subjects: Adult; Anti-Inflammatory Agents - therapeutic use; Antiretroviral Therapy, Highly Active - methods; Aspirin - therapeutic use; Biomarkers - blood; Blood Platelets - drug effects; Blood Platelets - immunology; Blood Platelets - virology; Clopidogrel - therapeutic use; Coronary Thrombosis - complications; Coronary Thrombosis - drug therapy; Coronary Thrombosis - immunology; Coronary Thrombosis - virology; Cross-Sectional Studies; Female; Fibrin Fibrinogen Degradation Products - genetics; Fibrin Fibrinogen Degradation Products - immunology; Gene Expression; Health and Medicine; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Humans; Immunity, Innate; Inflammation; Lipopolysaccharide Receptors - genetics; Lipopolysaccharide Receptors - immunology; Male; Middle Aged; Monocytes - drug effects; Monocytes - immunology; Monocytes - virology; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - therapeutic use; Receptors, Tumor Necrosis Factor, Type I - genetics; Receptors, Tumor Necrosis Factor, Type I - immunology; Receptors, Tumor Necrosis Factor, Type II - genetics; Receptors, Tumor Necrosis Factor, Type II - immunology; SciAdv r-articles
• ISSN: 2375-2548; 2375-2548
• DOI: 10.1126/sciadv.aav5463

Persons with HIV infection (PWH) have increased risk for cardiovascular disease (CVD), but the underlying mechanisms remain unclear. Coronary thrombosis is known to provoke myocardial infarctions, but whether PWH have elevated thrombotic propensity is unknown. We compared thrombogenicity of PWH on antiretroviral therapy versus matched controls using the Badimon chamber. Measures of inflammation, platelet reactivity, and innate immune activation were simultaneously performed. Enrolled PWH were then randomized to placebo, aspirin (81 mg), or clopidogrel (75 mg) for 24 weeks to assess treatment effects on study parameters. Thrombogenicity was significantly higher in PWH and correlated strongly with plasma levels of D-dimer, soluble TNF receptors 1 and 2, and circulating classical and nonclassical monocytes in PWH. Clopidogrel significantly reduced thrombogenicity and sCD14. Our data suggest that higher thrombogenicity, interacting with inflammatory and immune activation markers, contributes to the increased CVD risk observed in PWH. Clopidogrel exhibits an anti-inflammatory activity in addition to its antithrombotic effect in PWH.