Klein S K, Slim E J, de Kruif M D, Keller T T, ten Cate H, van Gorp E C M, Brandjes D P M
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
Neth J Med. 2005 Apr;63(4):129-36.
Infection with the human immunodeficiency virus (HIV) is still a major health problem world-wide. HIV infection has changed into a chronic infection with the chance of developing long-term complications. Vascular complications are frequently reported in the current literature. HIV and treatment by highly active antiretroviral therapy (HAART) are associated with many cardiovascular risk factors. An increased risk of arterial cardiovascular complications was found in a number of studies. However, data about the risk of venous thrombotic disease (VTE), including potentially fatal conditions as pulmonary embolism, were limited. In a systematic review of the literature, ten relevant epidemiological studies were identified that investigated the risk of venous thrombotic disease in HIV-infected patients. The incidence was increased two- to tenfold in comparison with a healthy population of the same age. However, these studies were mainly retrospective cohort studies that were prone to selection bias, confounding factors were not always mentioned and in all but three control populations were missing. An increased risk of venous thrombotic disease in HIV-infected patients could be explained by the presence of a hypercoagulable state, characterised by an increase in procoagulant factors, such as endothelial TF expression and thrombogenic properties of microparticles, and a decrease in anticoagulant factors, including AT III, HC II and the protein C pathway. Furthermore, the risk of VTE was associated with an increased risk of infections and autoimmune haemolytic anaemia, and was weakly associated with HAART. All together, quite some evidence pointed towards a relationship between HIV infection and venous thrombotic disease, but the association still needs to be established in properly designed epidemiological studies.
人类免疫缺陷病毒（HIV）感染仍是全球主要的健康问题。HIV感染已转变为一种慢性感染，有可能引发长期并发症。目前文献中经常报道血管并发症。HIV以及高效抗逆转录病毒疗法（HAART）治疗与许多心血管危险因素相关。多项研究发现动脉心血管并发症风险增加。然而，关于静脉血栓性疾病（VTE）风险的数据，包括如肺栓塞等潜在致命情况的数据有限。在一项系统文献综述中，确定了十项相关的流行病学研究，这些研究调查了HIV感染患者的静脉血栓性疾病风险。与同年龄的健康人群相比，发病率增加了两到十倍。然而，这些研究主要是回顾性队列研究，容易出现选择偏倚，混杂因素并非总是提及，而且除三项研究外，均缺少对照人群。HIV感染患者静脉血栓性疾病风险增加可由高凝状态来解释，其特征是促凝因子增加，如内皮组织因子（TF）表达和微粒的血栓形成特性，以及抗凝因子减少，包括抗凝血酶III（AT III）、肝素辅因子II（HC II）和蛋白C途径。此外，VTE风险与感染和自身免疫性溶血性贫血风险增加相关，并且与HAART存在弱关联。总体而言，相当多的证据表明HIV感染与静脉血栓性疾病之间存在关联，但仍需要在设计合理的流行病学研究中确立这种关联。
