In this study, the results show that participants on ART had significantly higher average platelet count as compared to ART-naïve patients. This indicates that ART may help improve the platelet count of HIV-infected people. Only 10% of the ART-naïve participants had platelet counts indicative of thrombocytopenia. Thrombocytopenia was also noted in reports from other research though it was unclear if the HIV patients were on HIV drugs [4, 5].

INR in a greater proportion of both subjects and controls were above the biological reference interval. In addition, APTT values of the majority of ART-experienced participants was normal. However a higher proportion of ART-naïve participants had prolonged APTT values when compared to the reference range. This is consistent with studies indicating that antiphospholipids or lupus anticoagulants, which were shown to occur in HIV patients as indicated in studies in Nigeria and USA, have been linked to prolonged APTT [6,7,8,9]. Also, average APTT values were lower in the ART-experienced compared to the ART-naïve patients albeit not statistically significant.

It is normally anticipated that HIV’s hypercoagulable state would result in shorter PT and APTT readings [10, 11]. However, in this investigation, the PT values in the HIV patients receiving ART and the ART-naïve controls showed a haemorrhagic tendency to be prolonged as observed in other studies among HIV positive subjects studies [7, 12, 13]. The liver plays a crucial role in coagulation and a problem therein may cause PT and APTT to be prolonged, predisposing HIV patients to bleeding tendencies. Difference in PT values between ART-experienced and ART-naïve participants was not statistically different as has been shown in a similar study [14].

This study showed that the particular ART regimen administered to patients had no apparent selective advantage in enhancing the coagulation profile in HIV patients receiving ART. In addition, no significant difference was observed in coagulation profiles between fully ART adherent participants and partially ART adherent participants, neither was there a significant difference in prevalence of male versus female drug compliant participants.

The study reported here had a number of limitations. The sample size was relatively low. Length of time patients had been on ART as well as viral load of ART-experienced participants and how that affected their coagulation profile was not factored into the analysis. Furthermore, the role of comorbidities like coinfections with other viruses such as hepatitis B [15], that could also affect outcomes of coagulation studies were not addressed. Hepatitis B is a sexually transmitted disease just as HIV is with highest endemicity found in sub-Saharan Africa [16] and hence one would expect to find coinfection among participants. Future studies would address all the above mentioned limitations.

In conclusions, the study demonstrated that any of the 2 ART regimens used for HIV first-line or second-line therapy could enhance the coagulation profile in HIV-infected patients by improving platelet count and APTT. To the best of our knowledge, this is the first coagulation profile studies in Ghana on these current ART combinations.