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

Abstract

ObjectiveThe association between HIV infection and the risk of venous thromboembolism (VTE) is controversial. We examined the risk of VTE in HIV-infected individuals compared with the general population and estimated the impact of low CD4 cell count, highly active antiretroviral therapy (HAART) and injecting drug use (IDU). MethodsWe identified 4333 Danish HIV-infected patients from the Danish HIV Cohort Study and a population-based age-and gender-matched comparison cohort of 43 330 individuals. VTE diagnoses were extracted from the Danish National Hospital Registry. Cumulative incidence curves were constructed for time to first VTE. Incidence rate ratios (IRRs) and impact of low CD4 cell count and HAART were estimated by Cox regression analyses. Analyses were stratified by IDU, adjusted for comorbidity and disaggregated by overall, provoked and unprovoked VTE. ResultsThe 5-year risk of VTE was 8.0% [95% confidence interval (CI) 5.78-10.74%] in IDU HIV-infected patients, 1.5% (95% CI 1.14-1.95%) in non-IDU HIV-infected patients and 0.3% (95% CI 0.29-0.41%) in the population comparison cohort. In non-IDU HIV-infected patients, adjusted IRRs for unprovoked and provoked VTE were 3.42 (95% CI 2.58-4.54) and 5.51 (95% CI 3.29-9.23), respectively, compared with the population comparison cohort. In IDU HIV-infected patients, the adjusted IRRs were 12.66 (95% CI 6.03-26.59) for unprovoked VTE and 9.38 (95% CI 1.61-54.50) for provoked VTE. Low CD4 cell count had a minor impact on these risk estimates, while HAART increased the overall risk (IRR 1.93; 95% CI 1.00-3.72). ConclusionHIV-infected patients are at increased risk of VTE, especially in the IDU population. HAART and possibly low CD4 cell count further increase the risk. DOI: 10.1111/j.1468-1293.00869.x HIV Medicine (2011 r 2010 British HIV Association 202 unrecognized even in modern health care systems [4]. It is important to clarify the main risk factors for VTE in order to identify individuals who may benefit from primary thromboprophylaxis [4,5]. Since the introduction of highly active antiretroviral therapy (HAART), HIV has become a chronic disease and life expectancy has increased substantially [6][7][8]. However, HIV-infected patients still experience considerable longterm treatment-associated morbidity.Recent studies of vascular disease in HIV-infected patients have focused on potential atherosclerotic complications in HAART-exposed patients [9,10]. In contrast, few studies have examined the risk of VTE in HIV-infected patients in the HAART era [11][12][13][14][15][16][17][18]. 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...

Proteomic landscape of bronchoalveolar lavage fluid in human immunodeficiency virus infection

“…Whereas the clinical implications of these findings in BALF require further study, HIV infection is strongly linked to increased risk of developing pulmonary hypertension (regardless of ART status) (39) and venous thromboembolism (32).…”

Deep Cerebral Venous Sinus Thrombosis (Cvt) with Excellent Recovery in HIV Patient on Antiretroviral Therapy

“…Protease inhibitors based therapy promotes thrombosis by inducing platelets and endothelial dysfunction [13]. Nonetheless it is still unclear whether non-protease inhibitors are prothrombotic or not [11,14]. Our patient is on reverse transcriptase inhibitors.…”

“…Inspite of the fact that the absolute risk of thrombosis in patients who are not on combined antiretroviral therapy is almost 6 folds in comparison to healthy population of the same age, there is an additional risk of thrombosis in patients on HAART [10,11]. The prothrombotic effect of HAART is reported to be more common in combinations including protease inhibitors (PIs) [12,13].…”

Interaction between inherited thrombophilia and HIV infection: fact or fancy?

“…This associa tion has been definitely established in a Danish population based study. 3 In Box 1 of our Review, 2 we identified that infectious diseases are associated with an increased risk of VTE, 4 but avoided detailing particu lar infectious agents. For example, acute Cytomegalovirus infection, which is far more common than HIV infection, doubles the risk of VTE.…”

“…Therefore, the statement that patients who are infected with HIV and carry one of the common mild thrombophilia abnormal ities should be considered at higher risk of VTE than individuals who are not infected with HIV remains speculative. Considering that combined antiretroviral therapy might increase the risk of VTE, 3 we prefer not to cause unwarranted alarm in the 6-8% of patients with HIV who carry hetero zygous factor V Leiden or the prothrombin mutation with assumptions that are not evidence based. …”