Journal des maladies infectieuses et de la thérapie

Abstrait

Venous Thromboembolic Disease during HIV Infection: Epidemiological, Clinical, Paraclinical, Therapeutic and Evolutionary Aspects in the Infectious and Tropical Diseases Department of Fann National University Hospital Centre (NHUC)

Diallo Mbaye Khardiata* , Ndèye Aïssatou Lakhe, Malick Mokhsine Diallo, Ndèye Maguette Fall, Daouda Thioub, Aboubakr Sadikh Badiane, Viviane MP Cisse Diallo, Daye Ka, Louise Fortes, Cheikh Tidiane Ndour, Masserigne Soumaré and Moussa Seydi

Introduction: Thromboembolic disease is increasingly reported in HIV infection. It affects the venous territory
with predilection. The arterial involvement, although uncommon, is increasingly reported. These thrombotic
accidents are thought to be multifactorial, due to a state of hypercoagulability caused by HIV itself, being responsible
for an immune imbalance, haemostasis disorders and a prolonged inflammatory pattern. Opportunistic infections
and the iatrogenic effects of anti-retrovirals are also thought to play a role.
Patients and methods: We carried out a retrospective, observational and descriptive study including HIV+
patients with venous thromboembolic disease in the Infectious Diseases Department of Fann National Hospital
University Centre (NHUC).
Results: We collected 36 cases of VTE for a total of 2,304 cases, corresponding to a hospital frequency of 1.6%.
There were 13 cases of Deep Vein Thrombosis (DVT) (76.5%) and four cases of pulmonary embolism (PE) (23.5%).
The sex ratio was 0.33 and the mean age was 39.94 years (18-68), with a mean hospital stay of 21.69 days (1-90).
Clinically, a large inflamed leg was noted in all cases of DVT. The circumstances of discovery of pulmonary
embolism were dominated by tachycardia, cough and dyspnoea. Elsewhere, chest pain (22.2%) and haemoptysis
(5.6%) were found. As for paraclinical investigations, venous ultrasound of the lower limbs had allowed to outline
thrombosis in all patients. The diagnosis of pulmonary embolism was possible thanks to thoracic angioscan. The
mean LTCD4 level was 71 cells/mm3. Tuberculosis was the most common opportunistic infection (59%), followed by
toxoplasmosis (2.8%) and herpes (2.8%). The main aetiological factors found were prolonged bed rest (100%), a
major medical condition (78%), advanced age (8.3%), pregnancy (5.5%) and contraception (5.5%). A regimen of
LMWH and VKA followed by VKA was prescribed in 83% of patients, and only 17% were on Direct Oral
Anticoagulants (DOA). Regarding ARV treatment, the majority were under TDF+3TC+EFV (61%). More than half of
the study population had an unfavourable outcome with a case fatality rate of 53%.
Conclusion: The current prognosis of HIV infection has improved considerably thanks to triple antiretroviral
therapy, but at the cost of complications, particularly thrombogenic ones. Thus, its management must be early and
adequate to reduce the risk of thrombosis and its complications. For this reason, a meticulous pre-therapeutic
assessment and a regular follow-up assessment must be requested.