Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

doi:10.7196/AJTCCM.2021.v27i3.155

. 2021 Oct 4;27(3):10.7196/AJTCCM.2021.v27i3.155.

doi: 10.7196/AJTCCM.2021.v27i3.155. eCollection 2021.

Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

P Moodley¹, N A Martinson^{2

3

4}, W Joyimbana², K N Otwombe², P Abraham², K Motlhaoleng², V A Naidoo¹, E Variava^{1

2

5}

Affiliations

¹ Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
² Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.
³ NRF/DST Centre of Excellence in Biomedical TB Research, Johannesburg, South Africa.
⁴ Center for TB Research, Johns Hopkins University Baltimore, USA.
⁵ Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, South Africa.

PMID: 34761207
PMCID: PMC8573812
DOI: 10.7196/AJTCCM.2021.v27i3.155

Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

P Moodley et al. Afr J Thorac Crit Care Med. 2021.

. 2021 Oct 4;27(3):10.7196/AJTCCM.2021.v27i3.155.

doi: 10.7196/AJTCCM.2021.v27i3.155. eCollection 2021.

Authors

P Moodley¹, N A Martinson^{2

3

4}, W Joyimbana², K N Otwombe², P Abraham², K Motlhaoleng², V A Naidoo¹, E Variava^{1

2

5}

Affiliations

¹ Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
² Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.
³ NRF/DST Centre of Excellence in Biomedical TB Research, Johannesburg, South Africa.
⁴ Center for TB Research, Johns Hopkins University Baltimore, USA.
⁵ Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, South Africa.

PMID: 34761207
PMCID: PMC8573812
DOI: 10.7196/AJTCCM.2021.v27i3.155

Abstract

Background: HIV and tuberculosis (TB) independently cause an increased risk for venous thromboembolic disease (VTE): deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Data from high HIV and TB burden settings describing VTE are scarce. The Wells' DVT and PE scores are widely used but their utility in these settings has not been reported on extensively.

Objectives: To evaluate new onset VTE, compare clinical characteristics by HIV status, and the presence or absence of TB disease in our setting. We also calculate the Wells' score for all patients.

Methods: A prospective cohort of adult in-patients with radiologically confirmed VTE were recruited into the study between September 2015 and May 2016. Demographics, presence of TB, HIV status, duration of treatment, CD4 count, viral load, VTE risk factors, and parameters to calculate the Wells' score were collected.

Results: We recruited 100 patients. Most of the patients were HIV-infected (n=59), 39 had TB disease and 32 were HIV/TB co-infected. Most of the patients had DVT only (n=83); 11 had PE, and 6 had both DVT and PE. More than a third of patients on antiretroviral treatment (ART) (43%; n=18/42) were on treatment for <6 months. Half of the patients (51%; n=20/39) were on TB treatment for <1 month. The median (interquartile range (IQR)) DVT and PE Wells' score in all sub-groups was 3.0 (1.0 - 4.0) and 3.0 (2.5 - 4.5), respectively.

Conclusion: HIV/TB co-infection appears to confer a risk for VTE, especially early after initiation of ART and/or TB treatment, and therefore requires careful monitoring for VTE and early initiation of thrombo-prophylaxis.

Keywords: HIV; deep vein thrombosis; prevalence; pulmonary embolism; tuberculosis; venous thromboembolism.

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Conflict of interest statement

Conflicts of interest: None.

Figures

**Fig. 1**
Patients grouped according to the duration of ART prior to onset of VTE (n=43) ART = antiretroviral therapy VTE = venous thromboembolism

**Fig. 2**
Patients grouped according to the duration of TB treatment prior to onset of VTE (n=38) ART = antiretroviral therapy VTE = venous thromboembolism

**Fig. 3**
Percentage of study population with traditional risk factors for VTE according to HIV status (n=100) VTE = venous thromboembolism

See this image and copyright information in PMC

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References

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1. Awolesi D, Naidoo M, Cassimijee MH. The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZuluNatal. S Afr J HIV Med. 2016;17(1):a425. doi: 10.4102/sajhivmed.v17i1.425. - DOI - PMC - PubMed
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[1] White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23):14–18. doi: 10.1161/01.cir.0000078468.11849.66. - DOI - PubMed

[2] White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23):14–18. doi: 10.1161/01.cir.0000078468.11849.66. - DOI - PubMed

[3] Awolesi D, Naidoo M, Cassimijee MH. The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZuluNatal. S Afr J HIV Med. 2016;17(1):a425. doi: 10.4102/sajhivmed.v17i1.425. - DOI - PMC - PubMed

[4] Awolesi D, Naidoo M, Cassimijee MH. The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZuluNatal. S Afr J HIV Med. 2016;17(1):a425. doi: 10.4102/sajhivmed.v17i1.425. - DOI - PMC - PubMed

[5] Bibas M, Biava G, Antinori A. HIV-associated venous thromboembolism. Mediterr J Haematol Infect Dis. 2011;3(1):e2011030. doi: 10.4084/mjhid.2011.030. - DOI - PMC - PubMed

[6] Bibas M, Biava G, Antinori A. HIV-associated venous thromboembolism. Mediterr J Haematol Infect Dis. 2011;3(1):e2011030. doi: 10.4084/mjhid.2011.030. - DOI - PMC - PubMed

[7] UNAIDS. Geneva: UNAIDS; 2021. South Africa – HIV and AIDS estimates.https://www.unaids.org/en/regionscountries/countries/southafrica (accessed 29 April 2021)

[8] UNAIDS. Geneva: UNAIDS; 2021. South Africa – HIV and AIDS estimates.https://www.unaids.org/en/regionscountries/countries/southafrica (accessed 29 April 2021)

[9] Crum-Cianflone NF, Weekes J, Bavaro M. Review: Thromboses among HIV-infected patients during the highly active antiretroviral therapy era. AIDS Patient Care STDs. 2008;22(10):771–778. doi: 10.1089/apc.2008.0010. - DOI - PMC - PubMed

[10] Crum-Cianflone NF, Weekes J, Bavaro M. Review: Thromboses among HIV-infected patients during the highly active antiretroviral therapy era. AIDS Patient Care STDs. 2008;22(10):771–778. doi: 10.1089/apc.2008.0010. - DOI - PMC - PubMed

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Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

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Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

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