Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;95(2):207-214.
doi: 10.1097/QAI.0000000000003339.

Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States

Heidi M Crane  1 , Robin M Nance  1 , Stephanie A Ruderman  1 , Lara Haidar  2 , Mark W Tenforde  1 , Susan R Heckbert  1 , Matthew J Budoff  3 , Andrew W Hahn  1 , Lydia N Drumright  1 , Jimmy Ma  1 , L S Mixson  1 , William B Lober  4 , Gregory S Barnes  5 , Justin McReynolds  5 , Engi F Attia  1 , Inga Peter  6 , Tesfaye Moges  7 , Laura Bamford  7 , Edward Cachay  7 , William C Mathews  7 , Katerina Christopolous  8 , Peter W Hunt  8 , Sonia Napravnik  9 , Jeanne Keruly  10 , Richard D Moore  10 , Greer Burkholder  11 , Amanda L Willig  11 , Sara Lindstrom  12 , Bridget M Whitney  1 , Michael S Saag  9 , Mari M Kitahata  1 , Kristina A Crothers  1 , Joseph A C Delaney  1   13
Affiliations

Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States

Heidi M Crane et al. J Acquir Immune Defic Syndr. .

Abstract

Background: People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era.

Methods: We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking.

Results: We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common.

Conclusions: We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.

PubMed Disclaimer

Conflict of interest statement

MB has received funding from General Electric, HMC has received a grant from ViiV HealthCare, for the remaining authors none were declared.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of potential VTEs
See this image and copyright information in PMC

References

    1. Weber R, Ruppik M, Rickenbach M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. Research Support, Non-U.S. Gov’t. HIV Med. Apr 2013;14(4):195–207. doi:10.1111/j.1468-1293.2012.01051.x - DOI - PubMed
    1. Palella FJ Jr., Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60. - PubMed
    1. Mocroft A, Phillips AN, Lundgren JD. HIV survival benefit associated with earlier antiviral therapy. Ann Intern Med. Apr 6 2004;140(7):578–9; author reply 579. - PubMed
    1. Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. Feb 11 1998;279(6):450–4. - PubMed
    1. Murphy EL, Collier AC, Kalish LA, et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. Jul 3 2001;135(1):17–26. - PubMed

Publication types

MeSH terms