An Update on HIV-associated Venous Thromboembolism in the Era of Highly Active Antiretroviral Therapy

Aboulafia D M.  An Update on HIV-associated Venous Thromboembolism in the Era of Highly Active Antiretroviral Therapy.  Journal of Coagulation Disorders, July 2010; 2(2):  49-56

REVIEW ARTICLE

David M. Aboulafia

Affiliations: Division of Hematology and Oncology, Virginia Mason Medical Center and Division of Hematology, University of Washington, Seattle, Washington, USA


ABSTRACT

HIV-associated morbidity and mortality have declined dramatically with the advent of highly active antiretroviral therapy (HAART). Prior to HAART, venous thromboembolism events (VTE) were infrequently described in HIV-infected patients. More recent epidemiologic surveys and case series suggest that VTE are 3-10 times more frequent in this group than age-matched controls. Several intersecting mechanisms associated with HIV infection, coupled with traditional risk factors, including advancing age, malignancies, and lifestyle choices, may contribute to their heightened risk of VTE. Optimal evaluation and management of VTE in HIV-infected individuals usually follows recommendations employed for the general population. Yet there are unique aspects to HIV care that suggest that such routine algorithms regarding thrombosis evaluation and treatment may not be universal. Given that HIV-infected patients can now anticipate living a near normal lifespan, VTE will emerge as an increasing problem in the coming decades. Emphasis on the potential benefits of therapeutic lifestyle changes that can minimize VTE risk is an essential component of integrated care of the HIV-infected patient. Additional study of factors that contribute to VTE risk in this population are needed as are long-term results of therapeutic interventions.

Keywords: HIV/AIDS, venous thromboembolism, highly active antiretroviral therapy

Correspondence: David M. Aboulafia, Clinical Professor of Medicine, University of Washington, 1100 Ninth Avenue, P.O. Box 900 (H14-HEM), Seattle, WA 98111-0900, USA. Tel: +1-206-341-1284; Fax: +1-206-223-2382; e-mail: hemdma@vmmc.org