Coagulation Factor Activity Levels in HIV-Positive Patients with Varying CD4 Counts at a Teaching Hospital in Enugu State, South East Nigeria

This study empirically evaluates coagulation factor activity levels across a spectrum of CD4 lymphocyte counts in HIV-positive patients at the University of Nigeria Teaching Hospital, Enugu State, South East Nigeria, addressing the understudied relationship between immunological deterioration and haemostatic factor depletion in Nigerian HIV populations. Haemostatic dysfunction in HIV is increasingly recognised but factor-specific data from this zone are lacking. A cross-sectional analytical study categorised 180 HIV-positive patients into three CD4 strata (below 200, 200 to 499, and 500 and above cells per microlitre) and recruited 60 HIV-negative controls. Factor VIII, IX, XI, von Willebrand factor antigen, protein C, and protein S activities were measured using a photo-optical coagulation analyser. The study identified progressive declines in protein C and protein S activity with declining CD4 count, reaching a 34 and 29 percent reduction respectively in patients with CD4 below 200 compared to controls. Factor VIII was paradoxically elevated across all HIV-positive strata, consistent with acute-phase endothelial activation. Protein C deficiency meeting diagnostic criteria was present in 22 percent of severely immunocompromised patients. Multivariate analysis identified viral load as an independent predictor of protein C deficiency. The findings fill an important gap in understanding the coagulopathic risk in advanced HIV in the South East Nigerian context and recommend protein C and protein S screening as part of advanced HIV haemostasiological assessment. Keywords: coagulation factors, HIV, CD4 count, protein C, South East Nigeria.