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Hypercoagulability Due to Protein S Deficiency in HIV-Seropositive Patients

Background: Thrombosis due to a hypercoagulable state is a serious clinical problem in HIV-infected individuals that can lead to life-threatening thromboembolic phenomenon.

Objective: To describe the salient clinical features of dual HIV infection and protein S deficiency.

Design: Retrospective case series.

Subjects: HIV seropositive patients with laboratory-confirmed protein S deficiency.

Results: Three patients had concurrent protein C deficiency. No patient had other primary or secondary risk factors for thrombophilia. Seven subjects had symptomatic thromboembolic manifestations that included deep venous thrombosis (5 subjects), pulmonary embolism (4 subjects), inferior vena cava thrombosis (2 subject), and/or stroke (1 subject). Five additional patients were identified with asymptomatic protein S deficiency. All subjects were African-American.; the mean patient age was 44 years (range, 21 to 60 years). The mean CD4+ cell count was 102 per mm3 (range 0-343), and the mean HIV RNA level was 71,772 copies/mL (range 1,421-554,237 copies/mL). Only three patients were receiving highly active antiretroviral therapy (HAART) at the time of clinical presentation. All symptomatic subjects received heparin, with or without warfarin, for their thromboembolic event and all but one recovered.

Conclusion: HIV-infected patients should be screened for acquired protein S deficiency, which contributes to hypercoagulability and risk of clinical thromboembolic events. Asymptomatic patients with reduced plasma free protein S levels may benefit from aspirin primary prophylaxis.

Author(s): Dragana Orlovic, Raymond A. Smego

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