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Semin Thromb Hemost
DOI: 10.1055/a-2574-8874
Review Article

Deep Vein Thrombosis in Adults with HIV: A Systematic Review and Meta-analysis of Prevalence and Risk Factors

Anas Ismail 
1   Department of Radiology, Bayero University, Kano, Nigeria
,
Abdulgafar Lekan Olawumi
2   Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
,
Zainab Abdulkadir
2   Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
,
Shehu A. Kana
3   Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
,
Fatima Adamu
4   Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
,
Aminu A. Yusuf
5   Department of Haematology and Blood Transfusion, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
,
Rabiu I. Jalo
6   Department of Community Medicine, Bayero University, Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
,
Fatimah I. Tsiga-Ahmed
6   Department of Community Medicine, Bayero University, Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
,
Muktar H. Aliyu
7   Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations Funding This work is partly supported by the Fogarty International Center (FIC) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the U.S. National Institutes of Health (NIH) award number 1D43TW011544. The findings and conclusions are those of the authors and do not necessarily represent the official position of the FIC, NIAAA, NIH, the Department of Health and Human Services, or the government of the United States of America.
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Abstract

Deep vein thrombosis (DVT) is a preventable yet serious complication among people living with human immunodeficiency virus (PLWH), attributed to hypercoagulability, low CD4+ counts, and antiretroviral therapy. Despite the high burden of human immunodeficiency virus (HIV), data on DVT in this population remain scarce, particularly in high-prevalence regions. This study systematically reviews the prevalence, risk factors, and outcomes of DVT in adults with HIV. Following PRISMA guidelines, we extracted data from 23 studies (180,495 participants) and conducted subgroup analyses based on country, continent, study design, and quality. Heterogeneity and publication bias were assessed statistically. The global DVT prevalence among PLWH was 14%, with Africa reporting the highest prevalence (47%) and Europe the lowest (3%). Kenya exhibited the highest country-specific prevalence (74%), whereas the Netherlands and Denmark had the lowest (2%). Cross-sectional studies reported the highest prevalence (16%). Identified risk factors included hospitalization, opportunistic infections, malignancies, and comorbidities such as hypertension and diabetes. Funnel plot asymmetry indicated potential publication bias and small-study effects. DVT poses a significant health burden among PLWH, particularly in Africa. Given the high prevalence and associated risk factors, integrating DVT prevention and management into HIV care is critical. Targeted interventions should focus on modifiable risk factors and enhanced diagnostic strategies to improve patient outcomes. Future studies should address knowledge gaps and methodological variations to guide better prevention and treatment approaches.

Keywords

deep vein thrombosis - HIV - prevalence - risk factors - pulmonary embolism

Authors' Contributions

All authors contributed significantly to this manuscript. A.I. led the conceptualization, methodology, data curation, analysis, drafting, and final approval. A.L.O. and A.I. conducted the literature search and data extraction. Z.A. handled data collection, quality assessment, and interpretation. F.I.T-A. critically reviewed the methodology and data interpretation. F.A. contributed to the study design, data verification, and proofreading. A.A.Y. focused on hematological aspects and risk factor evaluation. R.I.J. and F.I.T-A. performed data analysis using STATA. S.A.K. assisted in data synthesis and discussion writing. M.H.A. provided senior advisory input, manuscript review, and final approval. All authors reviewed and approved the final manuscript and are accountable for its content.




Publication History

Received: 20 March 2025

Accepted: 03 April 2025

Article published online:
25 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Birhane S, Beyene MG, Tadesse F, Baye AM. Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study. Thromb J 2024; 22 (01) 62
    PubMedSearch in Google Scholar
  • 2 Fang MC, Fan D, Sung SH. et al. Treatment and outcomes of acute pulmonary embolism and deep venous thrombosis: The CVRN VTE Study. Am J Med 2019; 132 (12) 1450-1457.e1
    CrossrefPubMedSearch in Google Scholar
  • 3 Al-Khafaji RA, Schierbeck L. Deep venous thrombosis in a patient with a moderate pretest probability and a negative D-dimer test: A review of the diagnostic algorithms. J Blood Med 2020; 11: 173-184
    PubMedSearch in Google Scholar
  • 4 McLendon K, Goyal A, Attia M. Deep Venous Thrombosis Risk Factors. StatPearls. Accessed August 2, 2025 at: https://www.ncbi.nlm.nih.gov/books/NBK470215/
    PubMed
  • 5 Zhang Q, Peng F, Li M, Yi Q, Tang W, Wu S. Elevated risk of venous thromboembolism in people living with HIV. Viruses 2022; 14 (03) 590
    PubMedSearch in Google Scholar
  • 6 Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol 2023; 20 (04) 248-262
    CrossrefPubMedSearch in Google Scholar
  • 7 Wendelboe AM, Raskob GE. Global burden of thrombosis: Epidemiologic aspects. Circ Res 2016; 118 (09) 1340-1347
    CrossrefPubMedSearch in Google Scholar
  • 8 Agrati C, Mazzotta V, Pinnetti C, Biava G, Bibas M. Venous thromboembolism in people living with HIV infection (PWH). Transl Res 2021; 227: 89-99
    PubMedSearch in Google Scholar
  • 9 Jackson BS, Pretorius E. Pathological clotting and deep vein thrombosis in patients with HIV. Semin Thromb Hemost 2019; 45 (02) 132-140
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Lijfering WM, Ten Kate MK, Sprenger HG, van der Meer J. Absolute risk of venous and arterial thrombosis in HIV-infected patients and effects of combination antiretroviral therapy. J Thromb Haemost 2006; 4 (09) 1928-1930
    PubMedSearch in Google Scholar
  • 11 Vululi ST, Bugeza S, Zeridah M. et al. Prevalence of lower limb deep venous thrombosis among adult HIV positive patients attending an outpatient clinic at Mulago Hospital. AIDS Res Ther 2018; 15 (01) 3
    CrossrefPubMedSearch in Google Scholar
  • 12 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    CrossrefPubMedSearch in Google Scholar
  • 13 Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015; 13 (03) 147-153
    PubMedSearch in Google Scholar
  • 14 Bissuel F, Berruyer M, Causse X, Dechavanne M, Trepo C. Acquired protein S deficiency: correlation with advanced disease in HIV-1-infected patients. J Acquir Immune Defic Syndr (1988) 1992; 5 (05) 484-489
    PubMedSearch in Google Scholar
  • 15 Le Gal G, Agnelli G, Darius H. et al. Event rates and risk factors for venous thromboembolism and major bleeding in a population of hospitalized adult patients with acute medical illness receiving enoxaparin thromboprophylaxis. Eur J Intern Med 2024; 121: 48-55
    PubMedSearch in Google Scholar
  • 16 Crane HM, Nance RM, Ruderman SA. et al. Venous thromboembolism among people with HIV: Design, implementation, and findings of a centralized adjudication system in clinical care sites across the United States. J Acquir Immune Defic Syndr 2024; 95 (02) 207-214
    PubMedSearch in Google Scholar
  • 17 Luu B, Ruderman S, Nance R. et al. Tobacco smoking and binge alcohol use are associated with incident venous thromboembolism in an HIV cohort. HIV Med 2022; 23 (10) 1051-1060
    PubMedSearch in Google Scholar
  • 18 Moodley P, Martinson NA, Joyimbana W. et al. Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB. Afr J Thorac Crit Care Med 2021;27(03)
    PubMed
  • 19 Duerksen DR, Ahmad A, Doweiko J, Bistrian BR, Mascioli EA. Risk of symptomatic central venous thrombotic complications in AIDS patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 1996; 20 (04) 302-305
    PubMedSearch in Google Scholar
  • 20 Saber AA, Aboolian A, LaRaja RD, Baron H, Hanna K. HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement. Am Surg 2001; 67 (07) 645-647
    CrossrefPubMedSearch in Google Scholar
  • 21 Saif MW, Bona R, Greenberg B. AIDS and thrombosis: retrospective study of 131 HIV-infected patients. AIDS Patient Care STDs 2001; 15 (06) 311-320
    PubMedSearch in Google Scholar
  • 22 Copur AS, Smith PR, Gomez V, Bergman M, Homel P. HIV infection is a risk factor for venous thromboembolism. AIDS Patient Care STDs 2002; 16 (05) 205-209
    PubMedSearch in Google Scholar
  • 23 Lijfering WM, Sprenger HG, Georg RR, van der Meulen PA, van der Meer J. Relationship between progression to AIDS and thrombophilic abnormalities in HIV infection. Clin Chem 2008; 54 (07) 1226-1233
    CrossrefPubMedSearch in Google Scholar
  • 24 Musselwhite LW, Sheikh V, Norton TD. et al. Markers of endothelial dysfunction, coagulation and tissue fibrosis independently predict venous thromboembolism in HIV. AIDS 2011; 25 (06) 787-795
    CrossrefPubMedSearch in Google Scholar
  • 25 Rasmussen LD, Dybdal M, Gerstoft J. et al. HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study. HIV Med 2011; 12 (04) 202-210
    CrossrefPubMedSearch in Google Scholar
  • 26 Modi RA, McGwin G, Westfall AO. et al. Venous thromboembolism among HIV-positive patients and anticoagulation clinic outcomes integrated within the HIV primary care setting. Int J STD AIDS 2015; 26 (12) 870-878
    PubMedSearch in Google Scholar
  • 27 van den Dries LWJ, Gruters RA, Hövels-van der Borden SBC. et al. von Willebrand Factor is elevated in HIV patients with a history of thrombosis. Front Microbiol 2015; 6: 180
    CrossrefPubMedSearch in Google Scholar
  • 28 Kanyi J, Karwa R, Pastakia SD, Manji I, Manyara S, Saina C. Venous thromboembolism requiring extended anticoagulation among HIV-infected patients in a rural, resource-constrained setting in Western Kenya. Ann Pharmacother 2017; 51 (05) 380-387
    CrossrefPubMedSearch in Google Scholar
  • 29 Ello FN, Bawe A, Kouakou GA. et al. Manifestations thromboemboliques chez 36 patients ouest africains infectés par le VIH. Pan Afr Med J 2018; 31: 224 . Accessed February 11, 2025 at: http://www.panafrican-med-journal.com/content/article/31/224/full/
    PubMedSearch in Google Scholar
  • 30 Howard JFB, Rokx C, Smit C. et al.; ATHENA observational HIV cohort investigators. Incidence of a first venous thrombotic event in people with HIV in the Netherlands: a retrospective cohort study. Lancet HIV 2019; 6 (03) e173 e181.
    CrossrefPubMedSearch in Google Scholar
  • 31 Rokx C, Borjas Howard JF, Smit C. et al.; ATHENA observational HIV cohort. Risk of recurrent venous thromboembolism in patients with HIV infection: A nationwide cohort study. PLoS Med 2020; 17 (05) e1003101
    CrossrefPubMedSearch in Google Scholar
  • 32 Zimba S, Nutakki A, Chishimba L. et al. Risk factors and outcomes of HIV-associated stroke in Zambia. AIDS 2021; 35 (13) 2149-2155
    CrossrefPubMedSearch in Google Scholar
  • 33 Keokgale T, van Blydenstein SA, Kalla IS. Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting. South Afr J HIV Med 2022; 23 (01) 1349
    PubMedSearch in Google Scholar
  • 34 White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 2009; 123 (Suppl. 04) S11-S17
    CrossrefPubMedSearch in Google Scholar
  • 35 Al-Ani F, Teng YL, Iansavichene A, Lazo-Langner A. Evaluating the effect of ethnicity on the risk of venous thromboembolism (VTE): A systematic review. Blood 2015; 126 (23) 4714-4714
    PubMedSearch in Google Scholar
  • 36 Zakai NA, McClure LA. Racial differences in venous thromboembolism. J Thromb Haemost 2011; 9 (10) 1877-1882
    CrossrefPubMedSearch in Google Scholar
  • 37 Patel RK, Arya R. Venous thromboembolism: racial and ethnic influences. Therapy 2008; 5 (02) 169-175
    PubMedSearch in Google Scholar
  • 38 Mahmoodi BK, Cushman M, Anne Næss I. et al. Association of traditional cardiovascular risk factors with venous thromboembolism: An individual participant data meta-analysis of prospective studies. Circulation 2017; 135 (01) 7-16
    CrossrefPubMedSearch in Google Scholar