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.