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Venous Thromboembolic Disease and Hypercoagulability in Human Immunodeficiency Virus Infection

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Cardiovascular Care in Patients With HIV

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.

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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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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Michael T. Bender & Sarah Louise O’Beirne

  2. Department of Genetic Medicine, Weill Cornell Medicine, New York, NY, USA

    Sarah Louise O’Beirne

Authors
  1. Michael T. Bender
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  2. Sarah Louise O’Beirne
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Corresponding author

Correspondence to Sarah Louise O’Beirne .

Editor information

Editors and Affiliations

  1. Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, USA

    Merle Myerson

  2. Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA

    Marshall J. Glesby

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Bender, M.T., O’Beirne, S.L. (2019). Venous Thromboembolic Disease and Hypercoagulability in Human Immunodeficiency Virus Infection. In: Myerson, M., Glesby, M. (eds) Cardiovascular Care in Patients With HIV. Springer, Cham. https://doi.org/10.1007/978-3-030-10451-1_14

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  • DOI: https://doi.org/10.1007/978-3-030-10451-1_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10450-4

  • Online ISBN: 978-3-030-10451-1

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