HIV and thrombosis: A review

The array of clinicopathologic factors associated with acquired immune defi ciency syndrome (AIDS) patients continues to increase and surprise many phy sicians. The recent literature contains reports of thrombotic episodes occu rring in patients with human immunodeficiency virus (HIV) infection. Variou s abnormalities predisposing to a hypercoagulable state have also been repo rted in AIDS patients including the presence of antiphospholipid antibodies and the lupus anticoagulant; deficiencies of protein C, protein S, heparin cofactor II, and antithrombin and increased levels of von Willebrand facto r, and d-dimers. These abnormalities correlate with the severity of HIV-ass ociated immunosuppression as measured by the CD4 cell counts and with the p resence of concurrent infectious or neoplastic diseases. The authors review ed the medical literature and describe various abnormalities predisposing t o a hypercoagulable state in AIDS patients along with the management of suc h complications. This issue is important because deep venous thrombosis (DV T), pulmonary embolus (PE), or thrombosis at other sites can develop in pat ients with AIDS who are ambulatory and have no known risk factors for patho logic thrombus formation, providing another challenge in an already difficu lt clinical situation. This also provides a strong rationale for careful pr ospective studies focusing on the prevalence and risk factors involved in t he development of thromboembolic complications in patients with AIDS.