Cytomegalovirus Infection, Ascending Myelitis, and Pulmonary Embolus

Bagley, Peter H.; Scott, Daniel A.; Smith, Leslie S.; Schillaci, Richard F.

doi:10.7326/0003-4819-104-4-587_1

Cited by 19 publications

(12 citation statements)

References 3 publications

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“…Our search yielded 129 cases, including our 17 cases10, 16, 17, 20, 22, 26, 31-33, 46-81. Forty-eight of the cases occurred prior to HAART (published before 1997 accounting for the lag time of publication) with the first cases being reported in 198646, 47; 81 cases have been reported in the literature after the widespread availability of HAART (1997-2007).…”

Section: Resultsmentioning

confidence: 99%

“…Forty-eight of the cases occurred prior to HAART (published before 1997 accounting for the lag time of publication) with the first cases being reported in 198646, 47; 81 cases have been reported in the literature after the widespread availability of HAART (1997-2007). The mean and median age of the VTE was 39.8 years and 37 years, respectively (range 22-70 years), and of those reporting gender, 84.9% were among males, likely related to the demographics of HIV-infected persons in the developed world from which the majority of cases were reported.…”

Section: Resultsmentioning

confidence: 99%

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Review:Thromboses among HIV-Infected Patients during the Highly Active Antiretroviral Therapy Era

Crum-Cianflone

Weekes²,

Bavaro³

2008

AIDS Patient Care and STDs

102

148

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Venous thrombotic events (VTEs) may occur at higher rates among HIV patients; some studies suggest that HAART may increase the risk for these potentially life-threatening events. We performed a retrospective study among HIV patients to evaluate the incidence and risk factors for VTEs during the HAART era. A literature review was performed examining VTEs in the pre-and post HAART eras. Seventeen (3.7%) of 465 HIV patients experienced a VTE. The overall incidence rate of deep VTEs among HIV positive persons was 377 cases/100,000 person-years, a four-fold higher rate compared to age-matched males in the general population. The median age at VTE was 36 years (range 27-68). Patients with a thrombosis compared to those without had significantly lower current CD4 (153 vs. 520 cells/mm 3 , p<0.001) and nadir (76 vs. 276 cells/mm 3 , p<0.001) CD4 counts, higher viral loads (3.6 vs. 1.7 log 10 copies/ml, p=0.003), and more likely to have a diagnosis of AIDS (76% vs. 32%, p<0.001); there were no differences in demographics, hyperlipidemia, current use of HAART, the duration of HAART or PI exposure. A review of the literature noted 129 VTE cases; mean age was 40 years, mean CD4 count was 181 cells/mm 3 , the majority of patients were not receiving HAART, and the most common risk factor was an ongoing infection. Thrombotic events are occurring among HIV patients despite their relatively young ages. Advanced HIV disease is a risk factor for development of thromboses, possibly due to an increased inflammatory state or the presence of concurrent comorbidities such as infections. HAART or PI therapy does not appear to play a significant role in the occurrence of VTEs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Review:Thromboses among HIV-Infected Patients during the Highly Active Antiretroviral Therapy Era

Crum-Cianflone

Weekes²,

Bavaro³

2008

AIDS Patient Care and STDs

102

148

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“…24,25 The presence of opportunistic infections may also predispose to thrombotic complications as shown by our study as well as a review of the literature. 11,14,[26][27][28][29][30][31] It is possible that the association between opportunistic infections and thrombotic complications in HIV-infected pa-tients may simply reflect immobility due to illness. Abnormalities in the hemostatic pathway such as positive antiphospholipid and lupus anticoagulant antibodies during PCP (14), and thrombotic events such as cytomegalovirus infection resulting in peripheral thrombophlebitis, strokes, digital infarcts, pulmonary embolus, cerebral venous thrombosis, 11,12,[26][27][28][29][30] and HIV itself causing central retinal vein occlusions, stroke, and cerebral venous thrombosis have been identified.…”

Section: Discussionmentioning

confidence: 99%

AIDS and Thrombosis: Retrospective Study of 131 HIV-Infected Patients

Saif

Bona

Greenberg

2001

AIDS Patient Care and STDs

111

131

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The recent literature contains reports of thrombotic episodes occurring in patients with human immunodeficiency virus (HIV) infection and various abnormalities predisposing to a hypercoagulable state have also been reported in such patients. To study the incidence of thrombosis in patients infected with HIV, and to assess the correlation of thrombosis with the degree of immunosuppression as well as the association with active illnesses and neoplasms, we reviewed the charts of 131 patients, which include all the patients with the diagnosis of HIV admitted or seen in the clinic between January 1, 1993, and January 1, 1998. The diagnosis of thrombosis was based on documented reports of venous plethysmography or venography for deep venous thrombosis and ventilation-perfusion scan or pulmonary angiography for pulmonary embolus. Risk factors for thrombotic disease were evaluated including general risk factors such as family history, ambulatory status, medications, and data were also collected regarding CD4 cell counts and the presence of concurrent or remote opportunistic infections, acquired immune deficiency syndrome (AIDS)-related malignancy or other AIDS-related diseases at the time of diagnosis of the thrombotic event. We also reviewed the medical literature via MEDLINE and found 45 cases of patients with HIV who developed thromboembolic complications. We found thrombotic complications in 9 of 37 patients with a CD4 count less than 200 cells/mm3 and in 1 of the remaining 94 patients with a CD4 count more than 200 cells/mm3. The difference was significant, with p = 0.00004, and the estimated odds of an event given CD4 cell counts less than 200/mm3 is 29.89 (95% confidence interval). Three patients had abnormalities of anticoagulation proteins. There was a history of opportunistic infections in 5 patients and malignancy in 3 patients. Two patients with autoimmune hemolytic anemia (AIHA) secondary to HIV-infection developed PE upon transfusion of packed red blood cells. The results of this study suggests that AIDS appears to predispose to thrombosis. It also revealed a significant correlation between thrombotic disease and CD4 counts (<200/mm3) as well as the presence of opportunistic infections, AIDS-related neoplasms, or autoimmune disorders associated with HIV such as AIHA. Therefore, clinicians caring for these patients should be aware of thromboembolic disease as a possible complication of AIDS. Further studies to elucidate the mechanisms underlying this abnormal hemostatic profile, the epidemiology, and to answer several questions such as should patients with risk factors for HIV infection who develop thromboembolic complications be further evaluated including tests for HIV are warranted.

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“…Certainly, thrombotic and other manifestations are much more frequently encountered than with other viral infections, again pointing to a major immunological disturbance in HIV as opposed to other viral conditions. However, dual infection with HIV and CMV has been reported as being associated with APS in a number of patients (Meyohas et al, 1998;Smith et al, 1995;Bagley et al, 1986;Jenkins et al, 1991).…”

Section: Human Immunodeficiency Virus (Hiv)mentioning

confidence: 96%