Issue: 2005 > April > review

Is chronic HIV infection associated with venous thrombotic disease? A systematic review

S.K. Klein, E.J. Slim, M.D. de Kruif, T.T. Keller, H. ten Cate, E.C.M. van Gorp, D.P.M. Brandjes


nfection with the human immunodeficiency virus (HIV)
is still a major health problem world-wide. HIV infection
has changed into a chronic infection with the chance of
developing long-term complications. Vascular complications are frequently reported in the current literature. HIV and treatment by highly active antiretroviral therapy (HAART) are associated with many cardiovascular risk factors. An increased risk of arterial cardiovascular complications was found in a number of studies. However, data about the risk of venous thrombotic disease (VTE), including potentially
fatal conditions as pulmonary embolism, were limited.
In a systematic review of the literature, ten relevant epidemiological studies were identified that investigated the risk of venous thrombotic disease in HIV-infected
patients. The incidence was increased two- to tenfold in
comparison with a healthy population of the same age.
However, these studies were mainly retrospective cohort
studies that were prone to selection bias, confounding
factors were not always mentioned and in all but three
control populations were missing. An increased risk of
venous thrombotic disease in HIV-infected patients could
be explained by the presence of a hypercoagulable state,
characterised by an increase in procoagulant factors, such as endothelial TF expression and thrombogenic properties of microparticles, and a decrease in anticoagulant factors, including AT III, HC II and the protein C pathway. Furthermore, the risk of VTE was associated with an increased risk of infections and autoimmune haemolytic anaemia, and was weakly associated with HAART. All together, quite some evidence pointed towards a relationship between HIV infection and venous thrombotic disease, but the association still needs to be established in properly
designed epidemiological studies.