Acute pulmonary embolism in patients with HIV disease

Abstract

in order to identify those with a diagnosis of PE. Results: During the study period there were 3792 admissions of whom 10 (0.26%) had PE. All patients with PE presented with fever, seven were dyspnoeic, and seven had cough: all were thought initially to have respiratory infection. Only five patients had pleural pain. All 10 patients had abnormal baseline chest radiographs. The diagnosis in six was made by computed tomograph (CT) pulmonary angiography, in two was made by ventilation perfusion (V/Q) scanning, in one by both techniques, and in one at necropsy. CT angiography in addition to identifying thrombus also showed concomitant lung parenchymal abnormalities in all but one patient. Nine patients with PE had one or more risk factors for venous thromboembolism as did 34/40 case matched controls (odds ratio = 1.67; 95% confidence interval = 0.18-15.5). All patients diagnosed in life were anticoagulated and five survived. Conclusions: PE was uncommon in this HIV infected population. The diagnosis should be considered in patients with respiratory infection which does not respond to antibiotics. Identifiable risk factors for venous thromboembolism appear to be unhelpful in increasing clinical index of suspicion for PE. As baseline chest radiographs are frequently abnormal, the diagnostic utility of V/Q scanning may be reduced and CT pulmonary angiography is the imaging modality of first choice. (Sex Transm Inf 1999;75:25-29) Keywords: pulmonary embolism; V/Q scan; angiography; HIV; AIDS IntroductionAcute pulmonary embolism is a common but potentially fatal condition that is frequently overlooked in life. In the general population, pulmonary emboli are directly responsible for 10% of all deaths in hospital and contribute to a further 10%.1 Several major risk factors for venous thromboembolism have been identified including recent abdominal surgery, disseminated malignancy, previous venous thromboembolism, immobilisation for more than 1 week, disabling cardiorespiratory disease, age >40 years, and thrombotic disorders.2-5 In contrast, reports of pulmonary embolism in HIV infected individuals are scarce, despite descriptions of the hypercoagulable state due to HIV associated lupus anticoagulant, anticardiolipin antibodies, and protein S deficiency.

HIV Infection Is a Risk Factor for Venous Thromboembolism

“…9 Although a relationship between HIV infection and VTE has been suggested in previously published case reports, 1-3 prior clinical studies have failed to confirm an association. 6,7 Autopsy studies on the other hand 4,5 have found a higher incidence of VTE in HIV1 patients than in the general population. 10 Our data also fail to show a significant correlation between HIV infection and VTE when uncorrected for age.…”

“…4,5 In contrast, clinical studies have not found a high incidence of VTE in HIV-positive (HIV1) individuals. 6,7 The latter reports did not examine the effect of age on the relationship between HIV status and VTE. Preliminary data at our hospital suggested a relatively high prevalence of HIV infection among patients under 50 years of age with VTE.…”

HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study

“…Studies mainly from the pre-HAART era estimated that the overall risk of VTE in patients with HIV infection was roughly 2-10-fold higher than expected in the general population [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. However, many studies were limited by small sample size [15,16,22,23] and a lack of a population-based comparison cohort [11][12][13]15,16,19,[21][22][23].AIDS-related opportunistic infections, neoplasms and HIV infection per se have been hypothesized to predispose patients to a hypercoagulable state [16]. Various other abnormalities in the haemostatic pathways of HIV-infected patients have also been reported [25][26][27].…”

Pulmonary embolism: an unsuspected killer

“…Many HIV-positive patients present with symptoms due to respiratory infections that are difficult to distinguish from PE. The diagnosis of PE still should be considered in HIV-positive patients with presumed respiratory infections who do not respond to antimicrobial therapy [76].…”