EXTENDED REPORT

Anticardiolipin, anti-ß₂-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease

S Loizou¹, S Singh¹, E Wypkema¹, R A Asherson²

¹ Lancet Laboratories, Johannesburg, South Africa
² Rheumatic Diseases Unit, The Groote Schuur Hospital, University of Cape Town School of Medicine, Cape Town and The Rosebank Clinic Johannesburg, South Africa

Correspondence to:
Correspondence to:
Dr S A Loizou, 37 Second Avenue, London W3 7RX, UK;
saloizou{at}aol.com

Objectives: To investigate IgG, IgM, and IgA, antiphospholipid antibodies (aPL), against cardiolipin (aCL), ß₂-glycoprotein I (anti-ß₂GPI), and prothrombin (anti-PT), in black South African patients with infectious disease. Unlike patients with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS), raised levels of aPL in infectious diseases are not usually associated with thrombotic complications.

Patients and methods: Serum samples from 272 patients with a variety of infectious diseases (100 HIV positive, 112 leprosy, 25 syphilis, 25 malaria, and 10 HCV patients) were studied and compared with autoantibody levels in 100 normal controls. All three aPL were measured using commercial enzyme linked immunosorbent assay (ELISA) kits.

Results: Raised levels of all thee aPL were found in all patient groups studied: aCL in 7%, anti-ß₂GPI in 6%, and aPT in 43% of 100 HIV patients, in 29%, 89%, and 21% of 112 patients with leprosy, in 8%, 8%, and 28% of 25 patients with syphilis, in 12%, 8%, and 28% of 25 patients with malaria, and in 20%, 30%, and 30% of 10 HCV patients studied, respectively.

Conclusions: The prevalence of aCL and anti-ß₂GPI in black South African HIV positive patients, or those with syphilis, malaria, or hepatitis C virus is lower than reported for mixed race or white populations. aPT were the most prevalent aPL detected in these patient groups, except in patients with leprosy, for whom anti-ß₂GPI was the most prevalent, and where the spectrum of aPL was similar to that seen in patients with SLE and APS.

Keywords: antiphospholipid antibodies; infections; black South Africans

Abbreviations: aCL, anticardiolipin antibodies; AEU, arbitrary ELISA units; aPL, antiphospholipid antibodies; APS, antiphospholipid syndrome; aPT, antiprothrombin antobodies; aPTT, activated partial thromboplastin time; ß₂GPI, ß₂-glycoprotein I; ELISA, enzyme linked immunosorbent assay; HCV, hepatitis C virus; LA, lupus anticoagulant; SLE, systemic lupus erythematosus

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