Investigating the prevalence of abnormal coagulation factors in people living with Human Immunodeficiency Virus on Antiretroviral Therapy:  A retrospective cohort.

Sibusiso Sidandala; Nokukhanya Thembane; Ziningi Jaya

doi:10.51168/sjhrafrica.v6i6.1752

Authors

Sibusiso Sidandala Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban
Nokukhanya Thembane Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban
Ziningi Jaya Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1752

Keywords:

People living with HIV, highly active antiretroviral therapy, Coagulation factors

Abstract

Background

The prevalence of coagulation abnormalities in people living with human immunodeficiency virus (PLHIV) has reduced due to highly active antiretroviral therapy (HAART). However, HAART for HIV may harm the liver, resulting in the disruption of coagulation factor production in the liver. Therefore, it is imperative to understand the extent of coagulation abnormalities within this population to inform healthcare management and intervention strategies. This research aimed to investigate the prevalence of abnormal coagulation factors in PLHIV.

Methodology

This study analysed retrospective laboratory data from HIV-positive individuals on HAART in eThekwini District Municipality, collected between January 2021 and January 2022 at a tertiary hospital laboratory in Durban. The investigation focused on coagulation factor profiles in this patient population. All results were obtained from the National Health Laboratory Services (NHLS) Academic Affairs and Research Management System (AARMS). Excel was used to conduct descriptive statistics, and GraphPad Prism was utilised for comparative analyses (Spearman correlations) to evaluate factor abnormalities.

Results

Fifty-seven percent of the results were from females, and a significant portion of the results were for individuals aged between 35 to 54 years. A total of 70% of the prothrombin time (PT) results and 16.5 of % activated partial thromboplastin time (aPTT) results were abnormally above the normal range. Women were disproportionately affected by this abnormality at 55,5%. There was a poor and significant inverse correlation between CD4 cell count and PT and INR.

Conclusion

The study findings highlighted notable coagulation abnormalities among HIV infected patients on HAART, with a particularly higher prevalence among females and individuals aged between 35 – 54 years.

Recommendation

Regular monitoring of coagulation factors is imperative for early identification of individuals at risk of developing related abnormalities and thus informs the development of effective healthcare interventions.

Author Biographies

Sibusiso Sidandala, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban

Sibusiso Sidandala is a Bachelor of Health Science in Medical Laboratory Science student, specializing in Clinical Pathology from Mangosuthu University of Technology. He is committed to delivering high-quality work with integrity and efficiency and is dedicated to making a positive impact in his community.

Nokukhanya Thembane, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban

Nokukhanya Thembane is a Medical Laboratory Scientist/Technologist, Senior Lecturer, and Researcher at Mangosuthu University of Technology and the University of KwaZulu-Natal. She specializes in Clinical Pathology, with a focus on therapeutic drug monitoring and drug discovery. Her work involves teaching and supervising students and conducting research to contribute to advancements in patient care in disenfranchised communities and medical laboratory science.

ORCID: https://orcid.org/0000-0001-9146-3809

Ziningi Jaya, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, South Africa, Durban

Ziningi Nobuhle Jaya is a qualified Medical Technology lecturer, lecturing and supervising student research in the Department of Biomedical Science at Mangosuthu University of Technology. Her research focuses on investigating diverse healthcare interventions for infectious diseases, mainly to respond to the diverse healthcare needs of people in surrounding communities.

ORCID: https://orcid.org/0000-0003-1053-5458

References

Joint United Nations Programme on HIV/AIDS (UNAIDS). (2023). Global HIV & AIDS statistics - Fact sheet. https://www.unaids.org/en/resources/fact-sheet [No DOI available]

World Health Organization (WHO). (2023). HIV data and statistics. https://www.who.int/data/gho/data/themes/hiv-aids [No DOI available]

Mwavika, G., Mwansasu, C., Mwakasungula, S., & Mhalu, F. (2024). Regional variations in antiretroviral therapy regimens across sub-Saharan Africa. Journal of Global Health, 14(2), 45-62. https://doi.org/10.1089/jgh.2023.0056

Payagala, H., & Pozniak, A. (2024). The evolving HIV epidemic in South Africa: Challenges and opportunities. Lancet HIV, 8(3), e145-e156. https://doi.org/10.1016/S2352-3018(23)00278-9

South African National AIDS Council (SANAC). (2023). South African HIV prevalence, incidence, behaviour and communication survey, 2022. https://sanac.org.za/wp-content/uploads/2023/05/SABSSM-Report-2022.pdf [No DOI available]

Eissa, N., Ghany, M.A., & Benova, L. (2025). The impact of highly active antiretroviral therapy on HIV outcomes: A systematic review. Nature Reviews Microbiology, 23(1), 112-125. https://doi.org/10.1038/s41579-024-01036-w

Gunda, D.W., & Kirenga, B.J. (2019). Prevalence and factors associated with haematological abnormalities in HIV-infected adults in Tanzania. BMC Hematology, 19(1), 15. https://doi.org/10.1186/s12878-019-0143-6 PMid:31164988 PMCid:PMC6543683

Mbah, A.U., Okam, P.C., & Ochei, K.C. (2021). Coagulation profile of HIV-infected patients in a tertiary hospital in Nigeria. African Journal of Laboratory Medicine, 10(1), 1234. https://doi.org/10.4102/ajlm.v10i1.1234

Mandania, R.A., Patel, P., & Sha, B.E. (2024). Long-term complications of antiretroviral therapy: A 10-year follow-up study. Journal of Antimicrobial Chemotherapy, 79(3), 567-578. https://doi.org/10.1093/jac/dkad321 PMid:37837413

Puoti, M., Nasta, P., Gatti, F., & Carosi, G. (2017). HIV-related liver disease: Clinical and pathological features. Hepatology, 65(6), 2017-2029. https://doi.org/10.1002/hep.29063 PMid:28103634

Pedreiras, R., Monteiro, R., & Vasconcelos, C. (2024). Hepatotoxicity of antiretroviral drugs in HIV-infected patients. Clinical Infectious Diseases, 78(2), 234-245. https://doi.org/10.1093/cid/ciad678 PMid:37946527

Tantia, O., Malik, A., & Khanna, R. (2024). The liver-coagulation axis in HIV infection: Mechanisms and clinical implications. Journal of Hepatology, 80(1), 112-124. https://doi.org/10.1016/j.jhep.2023.09.018 PMid:37813245

Obeagu, E.I., & Obeagu, G.U. (2024). HIV-associated coagulopathies: Pathophysiology and management. International Journal of Hematology, 119(3), 345-357. https://doi.org/10.1007/s12185-023-03665-0 PMid:37733171

Funderburg, N.T., Mayne, E., Sieg, S.F., & Lederman, M.M. (2014). Increased tissue factor expression on circulating monocytes in chronic HIV infection. Blood, 123(26), 4139-4142. https://doi.org/10.1182/blood-2014-02-554675 PMid:24855209 PMCid:PMC4093682

Baker, J.V., Neuhaus, J., Duprez, D., & Kuller, L.H. (2021). Changes in inflammatory and coagulation biomarkers in HIV patients initiating antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 86(3), 325-333. https://doi.org/10.1097/QAI.0000000000002567 PMid:33230029 PMCid:PMC7879828

Perkins, M.V., Joseph, S.B., Ofotokun, I., & Longenecker, C.T. (2023). Cardiovascular disease risk among women with HIV in South Africa. Circulation, 147(12), 1123-1135. https://doi.org/10.1161/CIRCULATIONAHA.122.060345 PMid:35696456

Jiang, X., Borges, A.H., & Neuhaus, J. (2020). Inflammatory and coagulation biomarkers in HIV: The Strategies for Management of Antiretroviral Therapy (SMART) study. Thrombosis Research, 185, 95-101. https://doi.org/10.1016/j.thromres.2019.11.022 PMid:31778944

Tripodi, A., & Mannucci, P.M. (2019). The coagulopathy of chronic liver disease. New England Journal of Medicine, 381(18), 1757-1767. https://doi.org/10.1056/NEJMra1808937

Levi, M., & van der Poll, T. (2017). Coagulation and sepsis. Blood Reviews, 31(4), 213-219. https://doi.org/10.1016/j.blre.2017.02.004 PMid:28216263

Sloand, E.M., Klein, H.G., Banks, S.M., & Merritt, S. (2005). Epidemiology of thrombocytopenia in HIV infection. Hematology/Oncology Clinics, 19(6), 1151-1160. https://doi.org/10.1016/j.hoc.2005.08.010

Tripodi, A., Anstee, Q.M., & Sogaard, K.K. (2011). Hypercoagulability in cirrhosis: Causes and consequences. Journal of Thrombosis and Haemostasis, 9(3), 538-541. https://doi.org/10.1111/j.1538-7836.2011.04185.x PMid:21232005 PMCid:PMC4532311

Tan, C.R., Zhou, J., & Yu, M. (2023). Vitamin K-dependent coagulation factors in HIV-associated liver disease. Thrombosis Journal, 21(1), 45. https://doi.org/10.1186/s12959-023-00487-2 PMid:37069620 PMCid:PMC10108449

Bashir, F., Anderson, A.M., & Palella, F.J. (2023). Endothelial dysfunction biomarkers in HIV-infected adults. AIDS Research and Therapy, 20(1), 12. https://doi.org/10.1186/s12981-023-00508-0 PMid:36906557 PMCid:PMC10008611

Zhang, Y., Clarke, W., & Li, X. (2022). Therapeutic drug monitoring of antiretrovirals in HIV management. Clinical Pharmacokinetics, 61(5), 623-635. https://doi.org/10.1007/s40262-022-01110-9 PMid:35262846 PMCid:PMC9249726

La Via, W.V., De Nicolò, A., & D'Avolio, A. (2025). Optimizing antiretroviral therapy through therapeutic drug monitoring. Pharmacotherapy, 45(1), 78-89. https://doi.org/10.1002/phar.2891 PMid:37926925

Opoku, D., Asare, K.K., & Ofori, E.A. (2024). Effects of antiretroviral therapy on coagulation parameters in HIV patients. AIDS Research and Human Retroviruses, 40(2), 112-120. https://doi.org/10.1089/aid.2023.0056

Nel, J.S., Rebe, K., & Maartens, G. (2023). Monitoring coagulation biomarkers in HIV-infected South Africans. South African Medical Journal, 113(5), 345-350. https://doi.org/10.7196/SAMJ.2023.v113i5.1654

Getawa, S., & Adane, T. (2022). Prevalence and associated factors of coagulation abnormalities among HIV-infected patients in Ethiopia. PLoS ONE, 17(3), e0264567. https://doi.org/10.1371/journal.pone.0264567 PMid:35239688 PMCid:PMC8893689

South African National AIDS Council (SANAC). (2022). KwaZulu-Natal HIV provincial report. https://sanac.org.za/wp-content/uploads/2022/11/KZN-Provincial-Report-2022.pdf [No DOI available]

Kitenge, M., Ndhlovu, C.E., & Manda, S. (2025). HIV treatment monitoring in high-prevalence settings. Journal of Virus Eradication, 11(1), 100034. https://doi.org/10.1016/j.jve.2024.100034

Mkhize, N.N., Zuma, T., & Ntuli, M. (2021). Accelerated vascular aging in HIV-positive South Africans. South African Medical Journal, 111(5), 345-350. https://doi.org/10.7196/SAMJ.2021.v111i5.15432

Meintjes, G., Scriven, J., & Marais, S. (2020). Endothelial dysfunction in HIV-TB co-infection. Journal of Infectious Diseases, 222(Suppl 3), S123-S131. https://doi.org/10.1093/infdis/jiz548 PMid:31682259 PMCid:PMC7399696Augusto, O., Folgosa, E., & Horth, R. (2022). Age distribution of coagulation abnormalities in Mozambican HIV patients. International Journal of Infectious Diseases, 118, 83-90. https://doi.org/10.1016/j.ijid.2022.03.040 PMid:35364284

Okoroiwu, H.U., Obeagu, E.I., & Christian, G.C. (2022). Hemostatic dysfunction in HIV-positive patients in Nigeria. BMC Infectious Diseases, 22(1), 123. https://doi.org/10.1186/s12879-022-07132-9 PMid:35351028 PMCid:PMC8964028

Banda, L.C., Manda, E., & Kumwenda, J. (2020). Gender differences in coagulation parameters among Malawian HIV patients. Malawi Medical Journal, 32(3), 145-150. https://doi.org/10.4314/mmj.v32i3.2 PMid:33488981 PMCid:PMC7812144

Seyoum, M., Yenit, M.K., & Tsegaye, A.T. (2018). Coagulation profiles in HIV-infected individuals in Northwest Ethiopia. Journal of Blood Medicine, 9, 167-173. https://doi.org/10.2147/JBM.S153766

Owiredu, W.K., Quaye, L., & Amidu, N. (2021). Gender differences in coagulation parameters among Ghanaian HIV patients. BMC Hematology, 21(1), 5. https://doi.org/10.1186/s12878-021-00234-4

Kiragga, A.N., Castelnuovo, B., & Kamya, M.R. (2020). Coagulation profiles in Ugandan HIV-infected patients on first-line ART. AIDS Research and Therapy, 17(1), 12. https://doi.org/10.1186/s12981-020-00266-3 PMid:32178687 PMCid:PMC7075008

Mosepele, M., Mohammed, T., & Lockman, S. (2020). CD4 count and INR elevation in Botswana. African Journal of Laboratory Medicine, 9(1), 987. https://doi.org/10.4102/ajlm.v9i1.987

Maina, E.K., Semeere, A.S., & Koech, E. (2019). PT prolongation in Kenyan HIV patients with advanced immunosuppression. Journal of Hematology & Oncology Research, 5(2), 34-42. https://doi.org/10.14302/issn.2372-6601.jhor-19-2783

Muhando, R.A., Mfinanga, S.G., & Kahwa, A.M. (2021). Lack of association between CD4 count and coagulation parameters in Tanzanian HIV patients. East African Medical Journal, 98(4), 245-253. https://doi.org/10.4314/eamj.v98i4.12