Homocysteine Levels in Patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in Ibadan

Abstract

Introduction: Homocysteine is produced from the conversion of methionine to cysteine. Conditions resulting in hyper homocysteinemia leads to an increased risk of both arterial and venous thromboembolisms by about 2 fold. 20% of HIV infected patients with objective evidence of venous thromboembolism are found to be thrombophilic with higher homocysteine levels. We enquired into homocysteine levels prior to the development of a clinical evidence of a venous thrombus in both HAART naïve and those on HAART of HIV /AIDS population. We evaluated the association between homocysteine, CD4 lymphocyte count and ART use in order to identify possible risk factors for hyper homocysteinemia in HIV population.

Method: Employing a cross sectional design; we compared mean plasma levels of homocysteine, full blood count parameters and CD4+ lymphocytes counts in HIV positive patients and HIV negative controls. One hundred and twenty patients with HIV infection attending the APIN clinic at the University College Hospital Ibadan and St Mary’s Catholic Hospital Eleta Ibadan and one hundred and twenty-six HIV negative healthy controls were compared in the study.

Results:  Fifty-nine point one percent of the HIV positive patient had hyperhomocysteinemia i.e. homocysteine levels of >18µmol/l. The mean plasma homocysteine levels were significantly higher at 24.4µmol/l (SD=13.8) (CI -2 to -8; p=0.002) in the HIV positive group compared with 19.5µmol/L (SD=10.6) in the control group.  The use of Anti-retroviral drugs was not associated with higher homocysteine level in the seropositive group and neither were factors like age, gender or the use of combined oral contraceptive pills. There was no correlation between CD4 cell count and homocysteine levels (r= -0.01; p=0.9).

Conclusion:  Homocysteine levels are elevated in HIV positive patients and hyperhomocysteinemia was found in a significant number of HIV positive patients. None of the patients investigated had features of thromboembolism or outright deep venous thrombosis. Neither CD4 cell counts nor traditional risk factors were associated with the higher homocysteine levels.