Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy.
Mediterr J Hematol Infect Dis. 2011;3(1):e2011030. doi: 10.4084/MJHID.2011.030. Epub 2011 Jul 8.
HIV infection has been recognized as a prothrombotic condition and this association has now been proven by a large number of studies with a reported VTE frequency among HIV-infected patients ranging from 0.19% to 7,63 %/year. HIV infection is associated with a two to tenfold increased risk of venous thrombosis in comparison with a general population of the same age. Some risk factors demonstrated a strongest association with VTE such as, low CD4(+) cell count especially in the presence of clinical AIDS, protein S deficiency, and protein C deficiency. Whereas other risk factors are still controversial like protease inhibitor therapy, presence of active opportunistic infections and presence of antiphospholipid antibodies, including anticardiolipin antibodies and lupus anticoagulant. Physicians caring for HIV positive patients should be able to recognize and treat not only the well-known opportunistic infections and malignancies associated with this chronic disease, but also be alert to the less well-known complications such as thromboses. Pulmonary embolism should be included in the differential diagnosis when patients with HIV/AIDS have unexplained dyspnea or hypoxemia. In younger individuals with VTE, especially men, without other identifiable risk factors for VTE, HIV should be considered. Because interactions between warfarin and antiretrovirals is possible, health care providers should also be alert to the potential of dangerously high or low INRs when they are giving anticoagulants to patients with HIV infection who are undergoing antiretroviral therapy.
HIV 感染已被认为是一种促血栓形成的病症，这一关联已被大量研究证实，报告显示 HIV 感染者的 VTE 发生率为 0.19%至 7.63%/年。与同年龄的一般人群相比，HIV 感染使静脉血栓形成的风险增加了 2 至 10 倍。一些危险因素与 VTE 密切相关，例如 CD4(+)细胞计数低，尤其是在存在临床艾滋病、蛋白 S 缺乏和蛋白 C 缺乏的情况下。而其他一些危险因素仍存在争议，如蛋白酶抑制剂治疗、活动性机会性感染和抗磷脂抗体的存在，包括抗心磷脂抗体和狼疮抗凝剂。治疗 HIV 阳性患者的医生不仅应该能够识别和治疗与这种慢性疾病相关的众所周知的机会性感染和恶性肿瘤，还应该警惕不太为人所知的并发症，如血栓形成。当 HIV/AIDS 患者出现不明原因的呼吸困难或低氧血症时，应将肺栓塞纳入鉴别诊断。在年轻的 VTE 患者中，尤其是男性，没有其他明确的 VTE 危险因素时，应考虑 HIV 感染。由于华法林和抗逆转录病毒之间可能存在相互作用，当他们给接受抗逆转录病毒治疗的 HIV 感染患者使用抗凝剂时，医疗保健提供者也应该警惕 INR 值过高或过低的潜在风险。
