HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study
- 18 August 2010
- journal article
- Published by Wiley in HIV Medicine
- Vol. 12 (4), 202-210
- https://doi.org/10.1111/j.1468-1293.2010.00869.x
Abstract
The 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). We 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. The 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). HIV-infected patients are at increased risk of VTE, especially in the IDU population. HAART and possibly low CD4 cell count further increase the risk.This publication has 40 references indexed in Scilit:
- Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional studyThe Lancet, 2008
- Survival of Persons with and without HIV Infection in Denmark, 1995–2005Annals of Internal Medicine, 2007
- Prevention of Venous ThromboembolismSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2004
- Combination Antiretroviral Therapy and the Risk of Myocardial InfarctionThe New England Journal of Medicine, 2003
- Highly Active Antiretroviral Therapy Decreases Mortality and Morbidity in Patients with Advanced HIV DiseaseAnnals of Internal Medicine, 2001
- Unexplained thrombosis in HIV-infected patients receiving protease inhibitors: report of seven casesThe American Journal of Medicine, 1999
- Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus InfectionThe New England Journal of Medicine, 1998
- Trends in the Incidence of Deep Vein Thrombosis and Pulmonary EmbolismArchives of Internal Medicine, 1998
- A prospective study of the incidence of deep‐vein thrombosis within a defined urban populationJournal of Internal Medicine, 1992
- A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT StudyArchives of Internal Medicine, 1991