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Venous Thromboembolic Disease and Hypercoagulability in Human Immunodeficiency Virus Infection

  • Michael T. Bender
  • Sarah Louise O’BeirneEmail author
Chapter

Abstract

Human immunodeficiency virus (HIV) infection is associated with an increased risk of venous thrombosis compared to that of the general population. In addition to traditional risk factors for venous thromboembolism (VTE) such as age, smoking and hospitalization, several of which are more prevalent in HIV-infected individuals, HIV-specific factors including the degree of immunosuppression, presence of opportunistic infections and malignancy, HIV-related coagulation abnormalities and medications used in the treatment of HIV, also contribute to this increased risk. The incidence of arterial thrombosis and cardiovascular disease is also increased in HIV infection, and VTE and arterial thrombosis share many risk factors. Importantly, increased chronic inflammation and immune activation persist in HIV infection even despite effective antiretroviral therapy and play an important role in these disease processes. Given the increased incidence of thrombosis in HIV, it is important that clinicians are alert to the condition in this population. Additionally, a diagnosis of HIV should be considered in individuals presenting with unexplained VTE.

Keywords

Deep venous thrombosis Pulmonary embolism Arterial thrombosis Thrombophilia Combined antiretroviral therapy CD4 Opportunistic infection Inflammation D-dimer Warfarin Novel oral anticoagulant 

Abbreviations

ACA

Anticardiolipin antibodies

ADAMTS13

A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13

APA

Antiphospholipid antibodies

APC

Activated protein C

AT

Antithrombin

cART

Combined antiretroviral therapy

CMV

Cytomegalovirus

CRP

C-reactive protein

CYP

Cytochrome P

DD

D-dimer

DDI

Drug-drug interaction

DIC

Disseminated intravascular coagulation

DVT

Deep vein thrombosis

FVL

Factor V Leiden

HCII

Heparin cofactor II

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

IL

Interleukin

INR

International normalized ratio

IVDU

Intravenous drug use

KS

Kaposi’s sarcoma

LA

Lupus anticoagulant

LPS

Lipopolysaccharide

MAI

Mycobacterium avium-intacellulare

MP

Microparticle

NNRTI

Non-nucleoside reverse transcriptase inhibitors

NOAC

Novel oral anticoagulants

NRTI

Nucleoside/nucleotide reverse transcriptase inhibitors

OI

Opportunistic infection

OR

Odds ratio

PC

Protein C

PE

Pulmonary embolus

Pgp

P-glycoprotein

PI

Protease inhibitor

PJP

Pneumocystis jirovecii pneumonia

PS

Protein S

RR

Relative risk

sPsel

Soluble P selectin

TF

Tissue factor

VL

Viral load

VTE

Venous thromboembolism

vWF

von Willebrand factor

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of MedicineNew York-Presbyterian Hospital/Weill Cornell MedicineNew YorkUSA
  2. 2.Department of Genetic MedicineWeill Cornell MedicineNew YorkUSA

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