Occlusive arterial disease in HIV-infected patients: a preliminary report

Objectives: to preliminarily describe the clinical features and management of arterial occlusive disease in human immunodeficiency virus (HIV) infecte d patients. Materials: twenty HIV positive patients with symptomatic large-vessel arter ial occlusion treated by a tertiary vascular unit in a 3-year period. Methods: retrospective review of clinical case records. Results: patients were noted to be young (median age 37 years), with prepon derance of males. Twelve patients had evidence of advanced HIV infection. A ll patients had critical ischaemia, involving the upper limbs in four and t he lower limbs in 16. Coagulation abnormalities were noted in two cases. Op erative intervention in 18 patients included revascularisation in seven. Th rombotic occlusion of normal-looking arteries was noted. Arterial biopsy re vealed leucocytoclastic vasculitis indicative of HIV arteritis in three of five cases examined. Conclusions: initial experience with large-vessel occlusive disease in HIV positive patients suggests an underlying arteritic aetiology, with clinical and pathological features distinct from atherosclerosis. Further in-depth study is necessary to clarify the pathophysiological basis thereof.