Majluf-Cruz Abraham, Silva-Estrada Mara, Sánchez-Barboza Rita, Montiel-Manzano Guadalupe, Treviño-Pérez Sandra, Santoscoy-Gómez Mario, de Chávez-Ochoa Adriana Ruiz, Corona-de la Peña Norma, Nieto-Cisneros Leopoldo
Unidad de Investigación en Epidemiología Clínica, Hospital General Regional Gabriel Mancera, IMSS, Mexico City, Mexico.
Clin Appl Thromb Hemost. 2004 Jan;10(1):19-25. doi: 10.1177/107602960401000104.
Thrombosis has been considered an uncommon complication in patients with AIDS. In a 42-month period, 28 adult male homosexuals with AIDS experienced 34 thrombotic events. All but three received HAART regimen, two a successful round of double nucleoside analog therapy, and one patient received no treatment. Median age of group was 38.5 years (range, 24 to 56 years). Median time from HIV infection to thrombosis was 40.5 months (range, 3 to 108 months). No patient had previous thrombosis, family history of thrombosis, or prothrombotic conditions. There were 31 deep vein thromboses, two pulmonary thromboembolisms, and one renal vein thrombosis. Six patients had two thrombotic events. The rate of thrombosis during the 42-month study period was 1.52% (cumulative incidence = 0.30%/year), while the rate of thrombosis in 600 patients before the era of protease inhibitor therapy was 0.33% (cumulative incidence approximately 0.055%/year) (p < 0.001). Due to high incidence of thrombotic recurrences and hemorrhagic complications while using oral anticoagulants, acetylsalicylic acid was initiated; no thrombotic episodes were recorded while using this drug. Protein C and protein S deficiency were found in nine and two patients, respectively. Two patients had lupus anticoagulant and two activated protein C resistance (APCR) without FV Leiden mutation (APCR test was negative after initial screening). Fifteen patients had no thrombophilic abnormalities. These data suggest that protease inhibitors could be a risk factor for venous thrombosis not due to thrombophilic abnormalities but likely related to abnormalities in platelets or endothelium.
血栓形成一直被认为是艾滋病患者中一种不常见的并发症。在42个月的时间里，28名成年男性同性恋艾滋病患者发生了34次血栓形成事件。除3人外，其余患者均接受了高效抗逆转录病毒治疗方案，2人成功进行了一轮双核苷类似物治疗，1名患者未接受治疗。该组患者的中位年龄为38.5岁（范围为24至56岁）。从感染HIV到发生血栓形成的中位时间为40.5个月（范围为3至108个月）。没有患者既往有血栓形成史、血栓形成家族史或血栓前状态。其中有31例深静脉血栓形成、2例肺血栓栓塞和1例肾静脉血栓形成。6名患者发生了2次血栓形成事件。在42个月的研究期间，血栓形成的发生率为1.52%（累积发病率=0.30%/年），而在蛋白酶抑制剂治疗时代之前，600名患者的血栓形成发生率为0.33%（累积发病率约为0.055%/年）（p<0.001）。由于使用口服抗凝剂时血栓形成复发和出血并发症的发生率较高，因此开始使用乙酰水杨酸；使用该药物期间未记录到血栓形成事件。分别在9名和2名患者中发现了蛋白C和蛋白S缺乏。2名患者有狼疮抗凝物，2名患者有活化蛋白C抵抗（APCR）但无FV Leiden突变（初始筛查后APCR试验为阴性）。15名患者没有血栓形成倾向异常。这些数据表明，蛋白酶抑制剂可能是静脉血栓形成的一个危险因素，并非由于血栓形成倾向异常，而是可能与血小板或内皮细胞异常有关。
