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.

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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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    • "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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