Dilute Russell’s viper venom time (dRVVT) and D-dimer as markers of haemostatic abnormalities in adult male and female living with HIV infection on HAART

Abstract Introduction Haemostatic abnormalities occur frequently in patients with HIV as a result of acquired deficiency of anticoagulant proteins and increased concentrations of coagulation and fibrinolytic markers. The aim of this study is to evaluate dilute Russell’s viper Venom Time (dRVVT) and D-dimer as markers of haemostatic abnormalities in adult male and female subjects living with HIV infection on Highly Active Antiretroviral Therapy (HAART). Methods A total of 60 subjects participated in the study consisting of 30 people living with HIV infection (PLWH) who had enrolled for 1 year and above and had been on HAART regimen treatment attending the Family Medicine Clinic of the University of Calabar Teaching Hospital, Calabar, Cross-River State, Nigeria and 30 control subjects who are age-matched and sero-negative for HIV infection and other viral infections (Hepatitis B and C) drawn from the general population. Ethical approval for the study was obtained from the University of Calabar Teaching Hospital Ethical Committee with an approval number UCTH/HREC/33/vol.111/301. A well-structured questionnaire was administered to each participant for bio-data and information/knowledge related to HIV infection and management as well as some clinical information obtained from their hospital folder for the PLWH. Blood samples were appropriately obtained from each subject for assessment of dRVVT, D-dimer, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT), CD4 count and viral load. Fibrinogen, dRVVT and D-dimer level were performed using Clauss method, clot-based method and ELISA, respectively, while PT, aPTT, and TT were assayed using the standard Quick One-stage method. CD4 count was done using the CyFlow analyzer, while viral load assay was carried out using Roche COBAS Taqman 48 analyzer molecular system. The SPSS version 22.0 was used for the statistical analysis of data. A p value of ≤ 0.05 was inferred to denote a statistically significant difference. The study period lasted for 6 months. Results Preponderance of female participation (56.7%) was recorded in the study group and among the female subjects, 63.3% of them were married. Seventy percent of the study group were on Tenofovir/Lamivudine/Dolutegravir (TLD), while the remaining 30% were on Abacavir/Lamivudine/Dolutegravir (ALD). Furthermore, 60% of the PLWH adhered to their medication. Significant prolonged PT, aPTT, TT, and elevated fibrinogen, D-dimer, and dRVVT (13.19 ± 1.27 s, 35.17 ± 4.31 s, 13.53 ± 1.02, 3.83 ± 0.46 g/L, 470.93 ± 31.94 ng/ml and 37.39 ± 20.45 s) were observed in PLWH when compared with the control group (12.07 ± 1.21 s, 22.47 ± 2.43 s, 11.59 ± 0.54, 2.81 ± 0.29 g/L, 360.20 ± 32.52 ng/ml and 29.70 ± 4.26 s). On the other hand, D-dimer and dRVVT were significantly reduced in subjects that adhered to their medication (476.11 ± 19.13 ng/ml and 28.53 ± 13.24 s) as against those who did not (513.17 ± 35.01 ng/ml and 50.66 ± 22.67 s). Furthermore, aPTT correlated negatively with D-dimer ( r = −0.362, p = 0.049) in PLWH, while dRVVT correlated positively with D-dimer ( r = 0.485, p = 0.007) in PLWH. Conclusions Significantly altered haemostatic parameters were observed in PLWH despite HAART treatment. However, adherence to HAART was associated with significantly lower D-dimer and dRVVT levels.