TY - JOUR
T1 - Venous Thromboembolism among People with HIV
T2 - Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States
AU - Crane, Heidi M.
AU - Nance, Robin M.
AU - Ruderman, Stephanie A.
AU - Haidar, Lara
AU - Tenforde, Mark W.
AU - Heckbert, Susan R.
AU - Budoff, Matthew J.
AU - Hahn, Andrew W.
AU - Drumright, Lydia N.
AU - Ma, Jimmy
AU - Mixson, L. S.
AU - Lober, William B.
AU - Barnes, Gregory S.
AU - McReynolds, Justin
AU - Attia, Engi F.
AU - Peter, Inga
AU - Moges, Tesfaye
AU - Bamford, Laura
AU - Cachay, Edward
AU - Mathews, William C.
AU - Christopolous, Katerina
AU - Hunt, Peter W.
AU - Napravnik, Sonia
AU - Keruly, Jeanne
AU - Moore, Richard D.
AU - Burkholder, Greer
AU - Willig, Amanda L.
AU - Lindstrom, Sara
AU - Whitney, Bridget M.
AU - Saag, Michael S.
AU - Kitahata, Mari M.
AU - Crothers, Kristina A.
AU - Delaney, Joseph A.C.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Background:People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era.Methods:We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking.Results:We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common.Conclusions:We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.
AB - Background:People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era.Methods:We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking.Results:We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common.Conclusions:We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.
KW - HIV
KW - deep venous thrombosis
KW - pulmonary embolism
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85182501468&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000003339
DO - 10.1097/QAI.0000000000003339
M3 - Article
C2 - 37988634
AN - SCOPUS:85182501468
SN - 1525-4135
VL - 95
SP - 207
EP - 214
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 2
ER -