Incidence of a first venous thrombotic event in people with HIV in the Netherlands
| Autor: | M. van der Valk, M.E.E. van Kasteren, Frank P. Kroon, Casper Rokx, M. Hillebregt, M.E. van der Ende, Selwyn H. Lowe, Emile F. Schippers, Jaime F Borjas Howard, S. Zaheri, J. W. Mulder, J. G. Den Hollander, Peter Reiss, Elise D. Pieterman, E. H. Gisolf, Bart J. A. Rijnders, Eliane M. S. Leyten, Colette Smit, Karina Meijer, Ferdinand W. N. M. Wit, Wouter F W Bierman, Kees Brinkman, Y. I. G. Vladimir Tichelaar |
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| Přispěvatelé: | Global Health, Infectious diseases, APH - Aging & Later Life, AII - Infectious diseases, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Internal Medicine, Medical Microbiology & Infectious Diseases |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Epidemiology Immunology Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Risk Assessment 03 medical and health sciences 0302 clinical medicine SDG 3 - Good Health and Well-being Virology Internal medicine medicine Humans 030212 general & internal medicine Netherlands Retrospective Studies Venous Thrombosis Proportional hazards model business.industry Incidence Incidence (epidemiology) Hazard ratio Retrospective cohort study Middle Aged Viral Load 030112 virology CD4 Lymphocyte Count Infectious Diseases Cohort Female Risk assessment business Viral load |
| Zdroj: | The Lancet HIV, 6(3), e173-e181. Elsevier Limited The Lancet, 6(3), e173-e181. ELSEVIER SCIENCE INC LANCET HIV, 6(3), e173-e181. Elsevier Ltd. |
| ISSN: | 2352-3018 0140-6736 |
| Popis: | BACKGROUND: The risk of venous thrombotic events is elevated in people with HIV, but overall risk estimates and estimates specific to immune status and antiretroviral medication remain i mprecise. In this study, we aimed to estimate these parameters in a large cohort of people with HIV in the Netherlands.METHODS: In this retrospective cohort study, we used the Dutch ATHENA cohort to estimate crude, age and sex standardised, and risk period-specific incidences of a first venous thrombotic event in people with HIV aged 18 years or older attending 12 HIV treatment centres in the Netherlands. Crude and standardised incidences were compared with European population-level studies of venous thrombotic events. We used time-updated Cox regression to estimate the risk of a first venous thrombotic event in association with HIV-specific factors (CD4 cell count, viral load, recent opportunistic infections, antiretroviral medication use) adjusted for traditional risk factors for venous thrombotic events.FINDINGS: With data collected from Jan 1, 2003, to April 1, 2015, our study cohort included 14 389 people with HIV and 99 762 person-years of follow-up, with a median follow-up of 7·2 years (IQR 3·3-11·1). During this period, 232 first venous thrombotic events occurred, yielding a crude incidence of 2·33 events per 1000 person-years (95% CI 2·04-2·64) and an incidence standardised for age and sex of 2·50 events per 1000 (2·18-2·82). CD4 counts less than 200 cells per μL were independently associated with higher risk of a venous thrombotic event: adjusted hazard ratio (aHR) 3·40 (95% CI 2·28-5·08) relative to counts of 500 cells per μL. A high viral load (aHR 3·15, 95% CI 2·00-5·02; >100 000 copies per mL vs INTERPRETATION: Our findings support neither prescribing primary outpatient thromboprophylaxis nor avoiding any type of antiretroviral medication in people with HIV at high risk of a venous thrombotic event.FUNDING: Dutch Ministry of Health, Welfare and Sport. |
| Databáze: | OpenAIRE |
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