Original research

Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB

P Moodley, N A Martinson, Wendy Joyimbana, K N Otwombe, P Abraham, K Motlhaoleng, V A Naidoo, E Variava

Abstract


Background. HIV and tuberculosis (TB) independently cause an increased risk for venous thromboembolic disease (VTE): deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Data from high HIV and TB burden settings describing VTE are scarce. The Wells’ DVT and PE scores are widely used but their utility in these settings has not been reported on extensively.

Objectives. To evaluate new onset VTE, compare clinical characteristics by HIV status, and the presence or absence of TB disease in our setting. We also calculate the Wells’ score for all patients.

Methods. A prospective cohort of adult in-patients with radiologically confirmed VTE were recruited into the study between September 2015 and May 2016. Demographics, presence of TB, HIV status, duration of treatment, CD4 count, viral load, VTE risk factors, and parameters to calculate the Wells’ score were collected.

Results. We recruited 100 patients. Most of the patients were HIV-infected (n=59), 39 had TB disease and 32 were HIV/TB co-infected. Most of the patients had DVT only (n=83); 11 had PE, and 6 had both DVT and PE. More than a third of patients on antiretroviral treatment (ART) (43%; n=18/42) were on treatment for <6 months. Half of the patients (51%; n=20/39) were on TB treatment for <1 month. The median (interquartile range (IQR)) DVT and PE Wells’ score in all sub-groups was 3.0 (1.0 - 4.0) and 3.0 (2.5 - 4.5), respectively.

Conclusion. HIV/TB co-infection appears to confer a risk for VTE, especially early after initiation of ART and/or TB treatment, and therefore requires careful monitoring for VTE and early initiation of thrombo-prophylaxis. Keywords. deep vein thrombosis; pulmonary embolism; venous thromboembolism; prevalence; tuberculosis; HIV.


Authors' affiliations

P Moodley, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

N A Martinson, Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa; NRF/DST Centre of Excellence in Biomedical TB Research, Johannesburg, South Africa; Center for TB Research, Johns Hopkins University Baltimore, USA

Wendy Joyimbana, Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

K N Otwombe, Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

P Abraham, Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

K Motlhaoleng, Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

V A Naidoo, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa

E Variava, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa; Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, South Africa

Full Text:

PDF (235KB)

Cite this article

African Journal of Thoracic and Critical Care Medicine 2021;27(3):99-105. DOI:10.7196/AJTCCM.2021.v27i3.155

Article History

Date submitted: 2021-10-01
Date published: 2021-10-04

Article Views

Abstract views: 36
Full text views: 15

Refbacks

  • There are currently no refbacks.



African Journal of Thoracic and Critical Care Medicine| Online ISSN: 2617-0205

This journal is protected by a Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) | Read our privacy policy.

Our Journals: South African Medical Journal | African Journal of Health Professions Education | South African Journal of Bioethics and Law | South African Journal of Child Health | Southern African Journal of Critical Care | South African Respiratory Journal South African Journal of Obstetrics and Gynaecology |