Venous thromboembolism in patients with HIV/AIDS

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2008; 48(3):310-4. DOI: 10.1097/QAI.0b013e318163bd70
Source: PubMed


Retrospective cohort studies of HIV-infected patients suggest an incidence of venous thromboembolism (VTE) of 1% to 2%, which is 10 times that expected among people without HIV. We investigated the prevalence of established risk factors for VTE in this population and explored novel risk factors.
We conducted a case-control study using patients in the Johns Hopkins University AIDS Service cohort. We used conditional logistic regression and paired t tests to test for covariates significantly associated with VTE.
We identified 160 patients with VTE diagnosed radiologically or with a clinical course consistent with VTE; 23% of the cases of VTE were diagnosed in hospitalized patients. The incidence of VTE was approximately 0.5% per patient-year. Patients with VTE and control patients did not differ by gender, but black patients were overrepresented among those with VTE (odds ratio [OR]=1.9, 95% confidence interval [CI]: 1.11 to 3.08) and patients with VTE were older than controls (mean: 39 vs. 37 years; P=0.001). Patients with VTE had lower CD4 counts (229 vs. 362 cells/mm; P<0.0001), higher HIV RNA titers (120,254 vs. 71,262 copies/mL; P=0.013), and lower hemoglobin concentrations (11.4 vs. 12.7 g/dL; P<0.0001) preceding the event than those without VTE. The use of highly active antiretroviral therapy was not associated with VTE. In multivariate analyses, independent risks for VTE were age, hospitalization in the past 3 months (OR=13, 95% CI: 6.4 to 27), central venous catheter use in the past 3 months (OR=6.0, 95% CI: 2.3 to 16), and a CD4 count<500 cells/mm (OR=3.0, 95% CI: 1.2 to 7.8).
The incidence of VTE in our cohort is similar to that reported in other cohorts of patients with HIV. Recent hospitalization was the risk factor most strongly associated with VTE.


Available from: Michael B Streiff
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    • "The numbers were small, and care has to be taken in making conclusions from these, but there is some literature that may support this finding. HIV-positive patients have an up to 10 times increased risk of venous thromboembolism (VTE) (Ahonkhai et al. 2008), and immobilization in traction can lead to PE (Sekimpi et al. 2011). Because of economic constraints, we did not have VTE prophylaxis with low-molecular-weight heparin or compressive stockings available at our hospital. "
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    ABSTRACT: Background Some surgeons believe that internal fixation of fractures carries too high a risk of infection in low-income countries (LICs) to merit its use there. However, there have been too few studies from LICs with sufficient follow-up to support this belief. We first wanted to determine whether complete follow-up could be achieved in an LIC, and secondly, we wanted to find the true microbial infection rate at our hospital and to examine the influence of HIV infection and lack of follow-up on outcomes. Patients and methods 137 patients with 141 femoral fractures that were treated with intramedullary (IM) nailing were included. We compared outcomes in patients who returned for scheduled follow-up and patients who did not return but who could be contacted by phone or visited in their home village. Results 79 patients returned for follow-up as scheduled; 29 of the remaining patients were reached by phone or outreach visits, giving a total follow-up rate of 79%. 7 patients (5%) had a deep postoperative infection. All of them returned for scheduled follow-up. There were no infections in patients who did not return for follow-up, as compared to 8 of 83 nails in the group that did return as scheduled (p = 0.1). 2 deaths occurred in HIV-positive patients (2/23), while no HIV-negative patients (0/105) died less than 30 days after surgery (p = 0.03). Interpretation We found an acceptable infection rate. The risk of infection should not be used as an argument against IM nailing of femoral fractures in LICs. Many patients in Malawi did not return for follow-up because they had no complaints concerning the fracture. There was an increased postoperative mortality rate in HIV-positive patients.
    Acta Orthopaedica 10/2013; 84(5). DOI:10.3109/17453674.2013.850014 · 2.77 Impact Factor
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    • "AIDS is considered to present many risk factors for VTE, including frequent hospitalization, the use of central venous catheters, an age older than 45 years, and the activation of endothelial cells from infections with cytomegalovirus, herpes, and HIV itself (34,35). The mean age of the AIDS patients in our study was 43.7 years, and the average hospital stay of these patients was only 11.1 days. "
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    Clinics (São Paulo, Brazil) 05/2013; 68(5). DOI:10.6061/clinics/2013(05)16 · 1.19 Impact Factor
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    ABSTRACT: L’infection par le virus de l’immunodéficience humaine (VIH) peut provoquer des complications vasculaires. Il s’agit le plus souvent de thrombose veineuse des membres inférieurs. De rares cas d’ischémie des membres révélatrice de l’infection à VIH ont été décrits. Nous rapportons un cas de thrombose veineuse du membre inférieur gauche et d’une ischémie artérielle bilatérale des membres inférieurs révélant une infection par le VIH 1 chez une patiente de 44 ans. Le taux de CD4 était de 195/mm3. L’exploration de la coagulation n’a pu être réalisée. La patiente a été amputée de ses deux membres inférieurs.
    Bulletin de la Société de pathologie exotique 106(1). DOI:10.1007/s13149-012-0273-6
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