HEMATOLOGICAL CHANGES IN HIV-INFECTED PREGNANT WOMEN DURING CHEMOPREVENTION WITH ANTIRETROVIRAL AGENTS

Objective. To reveal, on the basis of hemogram, hemostasiogram, and thromboelastogram readings, the pattern of anemia, thrombocytopenia, and hemocoagulation disorders in HIV-infected pregnant women receiving chemopreventive agents and to define ways of their correction. Subjects and methods. In the period December 2009 to November 2011, a prospective controlled clinical trial covering 162 pregnant women with V.I. Pokrovsky Classification Stage III HIV infection was conducted at the Interdistrict Perinatal Center, Clinical Hospital Five, Togliatti. The findings were statistically processed and analyzed at the Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia. Results and discussion. The authors’ laboratory data suggest that the HIV-infected pregnant women receiving chemopreventive agents have macrocytic anemia. The synthesis of red blood cells and hemoglobin is impaired due to suppressed erythropoiesis, as confirmed by the morphological pattern of red blood cells. The significant increase in the count of red blood cells and hemoglobin in the HIV-infected patients points to the positive impact of preoperative preparation. Preoperative specific therapy leads to a significant reduction in activated partial thromboplastin time, international normalized ratio, prothrombin time, and D-dimer and to an increase in spontaneous euglobulin lysis time and fibrogen levels, which is indicative of the normalization of the hemostatic system and the adequacy of chosen treatment policy. The significantly low coagulation indices lead to the conclusion that the HIV-infected pregnant women show a propensity to have hypocoagulation shifts due to the use of antiretroviral drugs. Conclusion. Both the data available in the literature and the authors’ observations suggest that the administration of antiviral agents causes certain changes in the homeostatic system, by most commonly inducing anemia, thrombocytopenia, and hypocoagulation shifts. Impaired erythropoiesis is a cause of anemia. The development of coagulopathy is associated with hepatic synthetic dysfunction and decreased formation of clotting factors. The authors’ preoperative goal-oriented preparation of HIV-infected pregnant women assists in leveling the occurred changes. Prednisolone therapy caused no significant increase in the count of platelets; consequently, it is necessary to have alternative ways of correcting these disorders. The performed studies underline the need for further investigations of the problem and the appropriateness of choosing alternative chemopreventive regimens.

pregnancy, HIV infection, antiretroviral therapy, anemia, thrombocytopenia, hemostatic disorders