Hypocoagulability among people living with HIV at Hoima Regional Referral Hospital, Western Uganda: a cross-sectional study

Abstract

BACKGROUND: Coagulation abnormalities are an under-recognized complication among people living with HIV. Despite widespread antiretroviral therapy (ART), hematologic dysfunction, including coagulation and platelet abnormalities, continues to contribute to morbidity in sub-Saharan Africa. OBJECTIVE: This study aimed to determine the prevalence, associated factors, and clinical features of hypocoagulability among people with HIV at Hoima Regional Referral Hospital (HRRH). METHODS: We conducted a cross-sectional study at HRRH, Western Uganda, from May to July 2025. Sociodemographic, clinical, and behavioral data were collected via questionnaires and chart review. Laboratory evaluation included platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR). Hypocoagulability was defined as ≥ 1 abnormal parameter: PT > 13.5 s, aPTT > 35 s, INR > 1.2, or platelet count <150,000/µL. Multivariable logistic regression identified independent factors associated with hypocoagulability. RESULTS: The study enrolled 389 HIV-positive adults. Hypocoagulability was detected in 121 participants (31.1%). The most frequent abnormalities were prolonged PT (14.1%), elevated INR (11.8%), prolonged aPTT (11.1%), and thrombocytopenia (9.3%). Independent factors associated with hypocoagulability included older age (aOR: 2.012, 95% CI = 1.165-4.813), alcohol use (aOR: 2.177, 95% CI = 1.250-3.792), ART-naïve status (aOR: 3.159, 95% CI 1.057-9.364), and unsuppressed viral load (aOR: 2.235, 95% CI = 1.297-3.851). Clinically, affected participants more commonly reported easy bruising (33.1%), frequent nose bleeds (29.8%), and heavy menstrual bleeding among women (39.2%) compared to participants without hypocoagulability. CONCLUSION: These findings highlight the importance of early detection, promotion of ART adherence, targeted screening of high-risk groups, and integrated management strategies to reduce bleeding-related morbidity in HIV care.