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1. Long-Term Trends of Coagulation Parameters in People Living With HIV Treated With Combined Antiretroviral Therapy

Author

Soerajja Bhoelan MD, Jaime Borjas Howard MD, Vladimir Tichelaar MD, PhD, Wouter Bierman MD, PhD, and Karina Meijer MD, PhD

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Trends of coagulation parameters during long-term treatment with combination antiretroviral therapy (cART) are unclear. We followed 40 male subjects living with human immunodeficiency virus (HIV). Plasma levels of procoagulant parameters, factor VIII, von Willebrand factor and D-dimer, and anticoagulant parameter Protein S (PS), were measured before start and 3 months, 1 year, and 9 years after. Analyses were adjusted for cardiovascular risk factors (age, smoking, and hypertension) at baseline. At baseline, procoagulant parameters were markedly elevated and PS was in the lower range of normal. CD4/CD8-ratio improved during the complete follow-up period. In the first year, procoagulant parameters were decreasing, but at year 9 an increase was observed. After correction for cardiovascular risk factors, this increase was no longer present. PS remained stable during the first year and slightly increased from one to 9 years. This study indicates that decreasing immune activation by cART reverses the procoagulant state in HIV partially during the first year. These parameters increase in the long term despite an on-going decrease in immune activation. This increase might be related to established cardiovascular risk factors.

Published
2023
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2. Recurrence risk of venous thromboembolism associated with systemic lupus erythematosus

Author

Soerajja Bhoelan, Jaime Borjas Howard, Vladimir Tichelaar, Paul van Daele, Liesbeth Hak, Alexandre Voskuyl, Maarten Limper, Robbert Goekoop, Onno Teng, Jelle Vosters, Marc Bijl, Els Zirkzee, Annemarie Schilder, Hein Bernelot Moens, Karina de Leeuw, Karina Meijer, Immunology, Internal Medicine, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Rheumatology, and AII - Inflammatory diseases

Subjects
systemic lupus erythematosus, inflammation, venous thromboembolism, Hematology, antiphospholipid syndrome, thrombosis
Abstract

BACKGROUND: Recurrence risk of systemic lupus erythematosus (SLE)-associated venous thromboembolism (VTE) is unclear.AIM: To determine the recurrence risk of SLE-associated VTE overall and by presence of provoking factors and SLE flares.METHODS: A multicenter, retrospective cohort study was conducted among patients with first SLE-associated VTE who discontinued anticoagulation. SLE flares were defined as Systemic Lupus Erythematosus Disease Activity Index 2000 greater than 4. The primary outcome was recurrent VTE. Incidence rates and cumulative incidences were calculated by presence of provoking factors and antiphospholipid syndrome (APS) at index VTE. The hazard ratio (HR) for recurrence after SLE flare-associated index VTE was estimated with Cox regression, adjusted for provoking factor presence and APS.RESULTS: Eighty patients were included with 21 recurrent VTEs in median 8 years. For provoked index VTE, the recurrence rate in patients without APS was 1.1 per 100 person-years (PY; 95% confidence interval [CI], 0.1-3.1) and in the presence of APS 3.5 per 100 PY (95% CI, 0.9-8.9), yielding cumulative incidences of 7.5% (95% CI, 1.2%-21.7%) and 31.4% (95% CI, 6.3%-61.6%) respectively. For unprovoked index VTE, these analogous rates were 3.8 per 100 PY (95% CI, 1.2-9.0) and 16.7 per 100 PY (95% CI, 4.5-42.7), with cumulative incidences of 33.7% (95% CI, 10.7%-58.9%) and 54.2% (95% CI, 10.7%-84.5%), respectively. Forty-six index VTEs were flare associated, and the adjusted HR for recurrence was 0.4 (95% CI, 0.1-1.8) compared to those without flares at their index VTE.CONCLUSION: Antiphospholipid syndrome is the main determinant for recurrence risk of SLE-associated VTE irrespective of presence of a provoking factor. Future research should attempt to confirm that flare-associated VTE has a lower recurrence risk.

Published
2022
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