Impact of short-term antiretroviral therapy (START) on some fibrinolytic markers in HIV-infected Nigerian adults: preliminary findings from the START study

BACKGROUND Derangement in fibrinolytic markers can result in thrombosis and cardiovascular problems. Antiretroviral therapy (ART) has been reported to affect the levels of these markers. It is unclear how long a patient can be exposed to ART before the effect of the drugs on the fibrinolytic markers becomes noticeable; this short-term antiretroviral therapy (START) study aimed to answer this question. METHODS Twenty human immunodeficiency virus (HIV)-positive subjects on ART and 20 controls (non-ART) were progressively monitored for three months. CD4 T-cell count was determined while D-dimer, t-PA, and PAI-1 parameters were determined. RESULTS CD4 T-cell count increased from 192 μL/mL at baseline to 323 μL/mL at month 3 among patients on ART. D-dimer concentrations decreased from 301.0 μL/mL at baseline to 172.0 μL/mL at month 2, then increased to 226.0 μL/mL at the end of the third month. The median baseline concentration of PAI-1 at the beginning of therapy was 14.0 μg/mL, which increased progressively to 18.2 μg/mL at the end of the third month. The baseline concentration of t-PA at the beginning of therapy was 5.15 μg/mL. This progressively declined to 1.10 μg/mL at the end of the first month and reached 1.45 μg/mL and 1.5 μg/mL at the end of the second and third months, respectively. D-dimer was positively and significantly correlated with CD4 cell counts in both AIDs-associated retrovirus (ARV) and non-ARV patients (r = -0.304, P < 0.01 vs r = -0.477, P < 0.001). t-PA was negatively correlated with CD4 T-lymphocytes in those undergoing ART (r = -0.294, P < 0.01). CONCLUSION A progressive increase in PAI-1 and steady decline in t-PA concentrations within 3 months of commencement of ART could predispose patients to thrombotic disorders earlier than is expected. Pre-thrombotic assessment during therapy is therefore advocated.