Abstract
Patients with human immunodeficiency virus (HIV) are at risk of developing thrombosis
and are 8 to 10 times more likely to develop thrombosis than the general population.
Moreover, if they have hypercoagulable state they can have severe thrombosis and life-threatening
thrombotic events. The purpose of this retrospective study is to analyze hypercoagulable
state in HIV-seropositive patients who have been diagnosed with venous thromboembolism
(VTE). This study is a subgroup study of a larger cohort group of HIV-seropositive
patients with VTE followed up with our vascular medicine outpatient clinic. The patients
included for this study were HIV-seropositive patients with hypercoagulable state,
analyzed over the past 3 years, and followed prospectively. HIV-seropositive patients
with arterial thrombosis were excluded. These patients had minimum, regular follow-up
of 3 months, with a Doppler scan in the beginning and last follow-up. All the patients
were analyzed for hypercoagulable state and the patients selected in this study were
those who were tested positive for hypercoagulable state. All patients were analyzed
for age, gender, race, site of thrombosis, coagulation factors, lipid panel, type
of antiretroviral treatment, past or present history of infections or malignancy,
CD4 absolute and helper cell counts at the beginning of thrombosis, and response to
treatment and outcome. Patients with HIV with arterial thrombosis were excluded. The
study was approved by the ethics committee. Five patients were included in this study.
The mean age was 47.8 years (range 38 to 58 years). All were male patients with lower
limb thrombosis. Most common venous thrombosis was popliteal vein thrombosis, followed
by common femoral, superficial femoral, and external iliac thrombosis. Two patients
had deficiency of protein S, two had high homocysteine levels, one had deficiency
of antithrombin 3, and one had increase in anticardiolipin immunoglobulin G antibody.
All the patients were taking nucleoside and nonnucleoside inhibitors but only one
patient was taking protease inhibitors. There was no history of malignancy but two
patients had past history of tuberculosis. The mean absolute CD4 counts were 244 cells/UL
(range 103 to 392 cells/UL) and helper CD4 counts were 19.6 cells/UL (range 15 to
30 cells/UL). All were anticoagulated with warfarin or enoxaparin. There was complete
resolution of deep vein thrombosis only in one patient on long-term anticoagulation
but there was no resolution of thrombosis in the other four patients despite of therapeutic
anticoagulation for more than 6 months. All the patients are alive and on regular
follow-up. Thrombosis in HIV patients is seen more commonly in middle aged, community
ambulant male patients. The most common hypercoagulable state was noted as deficiency
of protein S and hyperhomocysteinemia. Eighty percent of the patients did not respond
to therapeutic anticoagulation.
Keywords
deep vein thrombosis - duplex - DVT - enoxaparin - factor V Leiden - low molecular
weight heparin - proximal
