Hypofibrinolytic state in HIV-1-infected patients treated with protease inhibitor-containing highly active antiretroviral therapy

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 29; no. 5; p. 441
• Main Authors: Koppel, Kristina, Bratt, Göran, Schulman, Sam, Bylund, Håkan, Sandström, Eric
• Format: Journal Article
• Language: English
• Published: United States 15.04.2002
• Subjects: Adipose Tissue - metabolism; Adult; Antiretroviral Therapy, Highly Active - adverse effects; Blood Glucose; C-Reactive Protein - analysis; Cardiovascular Diseases - etiology; Fibrinogen - analysis; HIV Infections - drug therapy; HIV Protease Inhibitors - adverse effects; Humans; Insulin Resistance; Lipids - blood; Lipodystrophy - etiology; Middle Aged; Plasminogen Activator Inhibitor 1 - blood; Risk Factors
• ISSN: 1525-4135
• DOI: 10.1097/00042560-200204150-00003

Decreased insulin sensitivity, hyperlipidemia, and body fat changes are considered as risk factors for coronary heart disease (CHD). A clustering of such factors (metabolic syndrome [MSDR]) exponentially increases the risk. Impaired fibrinolysis and increased coagulation are additional independent risk factors for CHD. We studied the effects of protease inhibitor (PI)-containing highly active antiretroviral therapy (HAART) on metabolic and hemostatic parameters in 363 HIV-infected individuals, of whom 266 were receiving PI-containing HAART and 97 were treatment naive. The fasting plasma levels of insulin, glucose, triglycerides, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, plasminogen activator inhibitor type 1 (PAI-1), and fibrinogen were evaluated together with the areas of visceral adipose tissue and the visceral adipose tissue/subcutaneous adipose tissue area ratio. The levels of insulin, triglycerides, cholesterol, and low-density lipoprotein cholesterol; visceral adipose tissue area; low-density lipoprotein/high-density lipoprotein ratio; and visceral adipose tissue/subcutaneous adipose tissue area ratio were significantly increased in patients receiving PI-containing HAART compared with treatment-naive patients. The levels of PAI-1 and fibrinogen were significantly higher in patients receiving PI-containing HAART. PAI-1 levels were higher in individuals with MSDR but also in patients without MSDR who were receiving PI-containing HAART. PAI-1 was independently correlated to use of PI-containing HAART, triglyceride level, insulin level, and body mass index (p <.001). These findings suggest that patients receiving PI-containing HAART have decreased fibrinolysis and increased coagulability, which may thus represent additional risk factors for cardiovascular disease in this patient group.