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Von Willebrand Factor Propeptide to Antigen Ratio: Evidence of Endothelial Activation in HIV Infected Pregnancy

E. Schapkaitz1, E. Libhaber1, B. Jacobson1, M. Meiring2, H. Büller3

1University of Witwatersrand, Johannesburg, South Africa, 2University of Free State and National Health Laboratory Service, Bloemfontein, South Africa, 3University of Amsterdam, Amsterdam, Netherlands

Abstract Number: PB0743

Meeting: ISTH 2021 Congress

Theme: Role of Hemostatic System in Cancer, Inflammation and Immunity » Infection and Hemostatic Factors

Background: An increased incidence of venous thrombo-embolism (VTE) has been observed in human immunodeficiency virus (HIV) infected pregnant women in the era of antiretroviral therapy (ART). The extent to which endothelial activation contributes among virologically- suppressed HIV-infected pregnant women has not been studied. The plasma ratio of von Willebrand factor (VWF) propeptide to VWF antigen, which declines in normal pregnancy, has been identified as a useful marker of endothelial activation.

Aims: To assess the VWF propeptide to antigen ratio in all three trimesters of pregnancy and its relationship with HIV viral load (VL) and ADAMTS13

Methods: A cross-sectional analysis was performed in 89 HIV-infected virologically-suppressed patients on ART for 5 [7] years, 63 HIV-infected patients with VL >50 copies/ml and 85 matched HIV-uninfected women. Testing was measured in the first (6-12 weeks), second (13-26 weeks) and third trimesters (27-39 weeks). The study protocol was approved by the ethics committee of the University of the Witwatersrand (M-181018).

Results:
Comparison of von Willebrand Factor associated parameters between HIV-uninfected, HIV-infected with virological-suppression and HIV-infected with VL >50 copies/ml study groups

Elevated measurements of VWF propeptide to antigen ratio were observed, in the first, second and third trimesters, in the HIV-infected group with VL >50 copies/ml (1.9 ± 0.9, 1.7 ± 0.9, 1.6 ± 1.1) and the HIV-infected virologically-suppressed group (1.7 ± 0.7, 1.7 ± 0.4, 1.6 ± 0.5) as compared to the HIV-uninfected group (1.4 ± 0.6, 1.3 ± 0.4, 1.2 ± 0.3, p<0.05). This was associated with a modest reduction in ADAMTS13 activity per trimester in the HIV-infected group with VL >50 copies/ml (53.6 ± 23.3; 64.6 ± 29.2; 63.4 ± 26.5) and the HIV-infected virologically-suppressed group (55.1 ± 25.2; 62.7 ± 30.1; 71.5 ± 29.9 %) as compared to the HIV-uninfected group (84.5 ± 31.4; 92.9 ± 27.3; 96.1 ± 24.4, p<0.001). Antibodies directed against ADAMTS13 were not significantly increased in HIV infected pregnancies (p<0.05). There were no VTE cases in pregnancy or up to six-weeks postpartum.

Conclusions: HIV-infected virologically suppressed pregnant patients show persistent endothelial activation. 

To cite this abstract in AMA style:

Schapkaitz E, Libhaber E, Jacobson B, Meiring M, Büller H. Von Willebrand Factor Propeptide to Antigen Ratio: Evidence of Endothelial Activation in HIV Infected Pregnancy [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/von-willebrand-factor-propeptide-to-antigen-ratio-evidence-of-endothelial-activation-in-hiv-infected-pregnancy/. Accessed June 25, 2022.

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