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 WJA  Vol.5 No.2 , June 2015
Down Regulated Protein C Plasma Levels in the Absence of Factor V Leiden Mutation in HIV Patients: An Observational Study in Maiduguri, North-Eastern Nigeria
Abstract: Background: As life expectancy of HIV-infected patients increases with use of highly active antiretroviral therapy (HAART), protean haematologic manifestation including decreased activity of natural anticoagulants such as protein C may occur in the absence of genetic risk factors. Based on this preposition, we assessed the plasma level of protein C, and prevalence of factor V Leiden mutation among HIV-infected individuals. Our cohort consisted of 499 HIV-infected patients, of which 250 had AIDS, while 249 were either asymptomatic or had minor mucocutaneous infection consistent with WHO clinical stages I and II without features of AIDS. We also evaluated 251 healthy, HIV-negative subjects as controls. All participants were tested for plasma protein C levels and factor V Leiden (FVL) mutation (Arg 506 Gln) by automation and amplification created restriction enzyme site (ACRES) polymerase chain reaction, respectively. The prevalence of reduced protein C plasma levels among HIV positive patients was 20%; it was more prevalent among those that had AIDS compared with those without features of AIDS, but within WHO clinical stage I and II, (93.3% vs 6.7%) respectively. None of the control patients had either reduced protein C nor FVL mutation. All participants that demonstrated reduced protein C plasma levels demonstrated normal FVL genotype (1691G/G). Conclusion: Decreased protein C plasma levels can occur in HIV-infected patients in the absence of factor V Leiden mutation. The risk increases with severity of the disease. Deranged protein C plasma level increases the risk of hypercoagulable state in patients with advanced HIV disease; it should be considered among the causes of thrombo embolism in this group of patients.
Cite this paper: Obi, S. , Denue, B. , O. Martin, I. , M. Baba, M. , Amilo, G. , Kwayabura, S. and Ejeatulu, O. (2015) Down Regulated Protein C Plasma Levels in the Absence of Factor V Leiden Mutation in HIV Patients: An Observational Study in Maiduguri, North-Eastern Nigeria. World Journal of AIDS, 5, 76-82. doi: 10.4236/wja.2015.52009.
References

[1]   Shen, Y.P. and Frankel, E.P. (2004) Thrombosis and Hypercoagulable State in HIV Infected Patients. Clinical and Applied Thrombosis/Hemostasis, 10, 270-280.
http://dx.doi.org/10.1177/107602960401000311

[2]   Klein, S.K., Slim, E.J., de Kruifde, M.D., Keller, T.T., Ten Cate, H. and Van Gorp, E. (2005) Is Chronic HIV Infection Associated with Venous Thrombotic Disease? A Systematic Review. Netherland Journal of Medicine, 69, 129-136.

[3]   Eyal, A. and Vella, M. (2009) HIV and Venous Thrombotic Events. South African Journal of Surgery, 7, 93-95.

[4]   Opie, J. (2012) Haematological Complications of HIV Infection. The South African Medical Journal, 102, 465-468.

[5]   Walker, I.D. (2005) Inherited Thrombophila. In: Hoffbrand, V., Catovsky, D. and Taddenham, E.G.D., Eds., Postgraduate Hematology, 5th Edition, Wiley India, Blackwell Publishing Ltd., Oxford, 885-889.

[6]   Geoffery, K.C., Edward, G.D. and John, H.M. (2005) Protein C Pathway—Inhibition of Co Factors FVa and FVllla. Post Graduate Haematology, 5th Edition, Blackwell Publishing Ltd., Oxford, 802-804.

[7]   Dahlback, B. and Vittoutreix, B.O. (2003) Molecular Recognition in the Protein C Anticoagulant Pathway. Journal of Thrombosis and Haemostasis, 1, 1525-1531.
http://dx.doi.org/10.1046/j.1538-7836.2003.00299.x

[8]   Bauer, K.A. (2003) Management of Thrombophilia. Journal of Thrombosis and Haemostasis, 1, 1429-1434. http://dx.doi.org/10.1046/j.1538-7836.2003.00274.x

[9]   Stimmiler, M.M., Quismorio, F.P., McGehee, W.E., Boylan, T. and Sharma, O.P. (1989) Anticardiolipin Antibodies in Acquire Immunode Ficiency Syndrome. Archival international Medicine, 149, 1833-1834.
http://dx.doi.org/10.1001/archinte.1989.00390080091020

[10]   Ankri, A., Bonmarchand, M., Coutellier, A., Hensons, A. and Karmochkine, M. (1999) Antiphospholipid Antibodies Are Epiphenomenon in HIV Infected Patients. AIDS, 13, 1282-1283.
http://dx.doi.org/10.1097/00002030-199907090-00024

[11]   Bibas, M., Gianluigi, B. and Andrea, A. (2011) HIV Associated Venous Thomboembolism. Mediterrenian Journal of Hematology and Infectious Disease, 3, 2035-3006. http://dx.doi.org/10.4084/mjhid

[12]   Hooper, G., Philip, J. and Robeiro, A. (1994) Tumor Necrosis Factor-Alpha down Regulates Protein S Secretion in Human Micro Vascular and Umblical Vein Endothehal Cells. Hep G2 Hepatoma Cell Line. Blood, 84, 483-489.

[13]   Esmon, C.T. (2000) The Endothelial Cell Protein C Receptor. Thrombosis and Haemostasis, 83, 639-643.

[14]   Beverly, J. (2005) Hunt and Michael Greave. Acquired Venous Thrombosis. Postgraduate Haem-atology, 5th Edition, Black Well Publishing, Oxford, 905.

[15]   Javier, C. (2007) Immune Activation and Increased Prevalence of Thrombosis in HIV Infection. Journal of AIDS, 46, 375-376. http://dx.doi.org/10.1097/qai.0b013e31813eb7f6

[16]   World Health Organisation (2007) WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children. World Health Organisation.

[17]   (1993) Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS among Adolescents and Adults.

[18]   Kraus, M., Protein, C. and Protein, S. (1998) Factor V Leiden. In: Thomas, L., Ed., Clinical Laboratory Diagnostics Franktar. TH Book Verlag, Frankfurt, 621-625.

[19]   CLSI (2008) Collection, Transport, and Processing of Blood Specimen for Testing Plasma Based Coagulation Assay and Molecular Hemostasis Assay. Approved Guide Line 5th Edition CLSI Document H21-A5.

[20]   Siemens Healthcare Diagnostic Products (2008) Berichrom Protein C Reagent Kit, Procedure Manual OUVVG15 E0502 (194) CS/ST.

[21]   Erbe, M., Richerts, V., Bauesacha, M. and Lindhood, E. (2003) Acquired Protein C and Protein S Deficiencies in HIV Infected Patients. Clinical and Applied Thrombosis and Haemostasis, 9, 325-331.
http://dx.doi.org/10.1177/107602960300900408

[22]   Katie, K. and Melissa, B. (2011) Risk Factors for Venous Thromboembolism in Patients with HIV-Infection. Pharmacotherapy, 30, 1293-1304.

[23]   Christine, C. (2005) Haematology in HIV Disease. Postgraduate Haematology, 5th Edition, Blackwell Publishing Ltd., Oxford, 381-394.

[24]   Mayne, P.D. (2005) Liver and Gallstones in Clinical Chemistry in Diagnosis and Treatment. 6th Edition, India Book Power (Formerly ELST), 283-284.

[25]   De Visser, M.C., Rosendaal, F.R. and Bertina, R.M. (1999) A Reduced Sensitivity for Activated Protein C in the Absence of Factor V Leiden Increases the Risk of Venous Thrombosis. Blood, 93, 1271-1276.

 
 
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