The state of the fibrinolytic system in HIV-infected pregnant women and parturient women with thrombohemorrhagic risk factors
Keywords:HIV infection, thrombogemorrhagic complications, fibrinolysis system, antiretroviral therapy, pregnancy, childbirth
Purpose of the study: to explore the status of the fibrinolytic system in HIV-infected pregnant women and parturient women.
Materials and methods. 120 HIV-positive pregnant women with risk factors of thrombohemorrhagic complications were examined. The main group included: IA-O subgroup – 10 patients with HIV-infection stage I who received high-activity antiretroviral therapy before this pregnancy, IB-O subgroup – 20 patients with HIV-infection stage I who started high-activity antiretroviral therapy during this pregnancy, II-O – 21 pregnant women with HIV infection II clinical stage, III-O subgroup – 24 women with HIV-infection III clinical stage. Comparison group consisted of 45 patients with HIV infection without thrombohemorrhagic complications; control group consisted of 40 pregnant women and parturient women without HIV. D-dimer, soluble fibrin-monomer complexes, antithrombin III and XIIa-dependent fibrinolysis time were evaluated.
Study results. In II-O and III-O subgroups there were changes of fibrinolytic system state in 18–22 weeks of pregnancy – increased D-dimer and soluble fibrin-monomer complexes, XIIa-dependent fibrinolysis time prolongation and antithrombin III decreased. With pregnancy progression the main group with HIV stage III showed a significant increase of soluble fibrin-monomer complexes and D-dimer with a tendency to XIIa-dependent fibrinolysis time reduction and antithrombin III decreasing. In all women of the main group there were thrombosis signs. In subgroup III-O there were laboratory signs of fibrinolysis activation (shortening the time of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. Parturient women who started taking high-activity antiretroviral therapy during this pregnancy show a slowing of the fibrinolysis processes (shortening of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. In IB-O subgroup there was a further suppression of fibrinolysis (prolonging the time of XIIa-dependent fibrinolysis).
Conclusions. Changes in the fibrinolytic system toward suppression of the fibrinolysis process during pregnancy and it activation during labor are significantly present in HIV-infected pregnant women and in women with risk factors for thrombogemorrhagic complications.
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