Trial reportAIDS (London, England)2013
Platelet count kinetics following interruption of antiretroviral treatment.
Trial report in AIDS (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 16 citations in OpenAlex.
- HIV replication alters the composition of extrinsic pathway coagulation factors and increases thrombin generation.Journal of the American Heart Association · 2013Trial
- Anti-GPIIIa antibody and CD4 count identify an autoimmune-enriched phenotype of HIV-associated thrombocytopenia: development and internal validation of a clinical nomogram.Frontiers in immunology · 2026Article
- Review
- Placental Structure in Preterm Birth Among HIV-Positive Versus HIV-Negative Women in Kenya.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South Africa.Clinical epidemiology · 2019Article
- Systemic inflammation-based scores and mortality for all causes in HIV-infected patients: a MASTER cohort study.BMC infectious diseases · 2017Observational
- Acute coronary syndromes in patients with HIV.Coronary artery disease · 2017Review
- Risk of coronary heart disease in patients with HIV infection.Nature reviews. Cardiology · 2014Review
- Depression Correlates with Increased Plasma Levels of Inflammatory Cytokines and a Dysregulated Oxidant/Antioxidant Balance in HIV-1-Infected Subjects Undergoing Antiretroviral Therapy.Journal of clinical & cellular immunology · 2014Article
- Hyaluronic acid levels predict risk of hepatic encephalopathy and liver-related death in HIV/viral hepatitis coinfected patients.PloS one · 2013Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 5 countries.
Funding
Abstract
objectivesTo investigate the mechanisms of platelet kinetics in the Strategies for Management of Antiretroviral Therapy (SMART) study that demonstrated excess mortality with CD4 guided episodic antiretroviral therapy (ART) drug conservation compared with continuous treatment viral suppression. Follow-up analyses of stored plasma samples demonstrated increased activation of both inflammatory and coagulation pathways after stopping ART.
designSMART patients from sites that determined platelets routinely.
methodsPlatelet counts were retrospectively collected from 2206 patients from visits at study entry, and during follow-up. D-dimer levels were measured at study entry, month 1, and 2.
resultsPlatelet levels decreased in the drug conservation group following randomization, but remained stable in the viral suppression group [median (IQR) decline from study entry to month 4: -24 000/μl (-54 000 to 4000) vs. 3000 (-22 000 to 24 000), respectively, P < 0.0001)] and the rate of developing thrombocytopenia (<100 000/μl) was significantly higher in the drug conservation vs. the viral suppression arm (unadjusted drug conservation/viral suppression [HR (95%CI) = 1.8 (1.2-2.7)]. The decline in platelet count among drug conservation participants on fully suppressive ART correlated with the rise in D-dimer from study entry to either month 1 or 2 (r = -0.41; P = 0.02). Among drug conservation participants who resumed ART 74% recovered to their study entry platelet levels.
conclusionInterrupting ART increases the risk of thrombocytopenia, but reinitiation of ART typically reverses it. Factors contributing to declines in platelets after interrupting ART may include activation of coagulation pathways or HIV-1 replication itself. The contribution of platelets in HIV-related procoagulant activity requires further study.
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