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HIV and HIV/HCV Boost Risk of Venous Thromboembolism in Large Veterans Cohort
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
HIV infection raised the risk of venous thromboembolism in a 445,400-person US veterans cohort [1]. Dual infection with HIV and HCV compounded the risk.
Because people with chronic infection may be predisposed to venous thrombosis (blood clots) [2,3], researchers from the University of Pittsburgh and other sites conducted this study to assess the impact of HIV and HCV on thrombosis risk. They used data from the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), which includes demographic, clinical, lab, pharmacy, and mortality data on 222,700 HCV-positive veterans and 222,700 veterans without HCV identified between 2001 and 2008. This cohort included 7641 people with HIV infection.
Among all veterans in the cohort, the researchers identified 3965 new cases of venous thromboembolism. Incidence of venous thrombosis measured 2.18 per 1000 person-years in veterans with neither HIV nor HCV, 2.43 in those with HCV only, 2.89 in those with HIV only, and 3.49 in those with HIV/HCV coinfection. Compared with veterans negative for both HIV and HCV, those with HIV alone had a 24% higher risk of venous thrombosis (incidence risk ratio [IRR] 1.24), a nonsignificant increase (95% confidence interval [CI] 0.88 to 1.75). But veterans infected with both HIV and HCV had a significant 36% higher risk of thrombosis (IRR 1.36, 95% CI 1.06 to 1.74).
Poisson regression analysis determined that, by itself, HIV infection raised the risk of a thrombotic event about 30% (see following list), while HCV alone did not boost the risk:
Variables associated with an incident thrombotic event:
-- Cirrhosis: IRR 3.11, 95% CI 2.73 to 3.54
-- Central venous catheter: IRR 3.10, 95% CI 2.74 to 3.50
-- Congestive heart failure: IRR 2.22, 95% CI 1.98 to 2.49
-- Cancer or cancer history: IRR 2.12, 95% CI 1.94 to 2.32
-- Chronic kidney disease: IRR 1.83, 95% CI 1.69 to 1.98
-- Chronic obstructive pulmonary disease: IRR 1.54, 95% CI 1.40 to 1.69
-- Stroke: IRR 1.62, 95% CI 1.34 to 1.95
-- HIV: IRR 1.31, 95% CI 1.07 to 1.60
-- Alcohol abuse: IRR 1.15, 95% CI 1.05 to 1.26
Age, being black of Hispanic, male gender, drug abuse, HCV, and cryoglobulinemia did not affect chances of venous thrombosis in this analysis.
An adjusted Kaplan-Meier analysis determined that HCV-positive veterans with thrombosis had the worst survival, followed by HCV-negative veterans with thrombosis and HCV-positive veterans without thrombosis; HCV-negative veterans without thrombosis had the best survival in this analysis.
The researchers suggested "providers should have a high suspicion of venous thromboembolic events in HIV and HIV/HCV-coinfected persons in the appropriate clinical settings."
References
1. Kasi P, Mohanty A, Erqou S, et al. HIV infection and risk of venous thromboembolism. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 781. http://www.retroconference.org/2013b/PDFs/781.pdf
2. Mayo Clinic. Deep vein thrombosis (DVT).
http://www.mayoclinic.com/health/deep-vein-thrombosis/DS01005
3. National Heart, Lung, and Blood Institute. Explore deep vein thrombosis. http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/
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