The profile of HIV/aids patients admitted with Deep Venous Thrombosis (DVT) at Nelson Mandela Hospital in Mthatha, South Africa
Thesis (MFamMed)--Stellenbosch University, 2010.
ENGLISH SUMMARY : Background: It has been found that HIV infection predisposes to a hypercoagulable state and that the risk of venous thromboembolism is about 10times that expected among people without HIV. Deep vein thrombosis (DVT) has been reported to be more common among HIV infected people in several parts of the country. No formal research has been published to confirm or refute this observation within the South African context. There has thus been the need to determine the true prevalence of deep vein thrombosis among patients with HIV infection in the medical ward of Nelson Mandela Hospital, Mthatha, South Africa. Aim: To determine the risk profile and prevalence of Deep Venous Thrombosis (DVT) in patients admitted with HIV/AIDS at the Nelson Mandela Hospital. Objectives: The main objectives of this study were: • To determine the proportion of patients admitted with DVT who also had HIV/AIDS. • To obtain a profile of the risk factors associated with DVT in patients requiring admission for DVT. • To describe the association of DVT and HIV/AIDS in subgroups of patients with different degrees of immunosuppression. Methods: We conducted a study in which we collected data retrospectively on all DVT cases admitted over a year period. Detailed information was collected about HIV status,CD4 count, and other risk factors for DVT. Results: A total of 102 DVT cases were admitted over the period of one year and data was extracted from the charts. A total of 81 (79.4%) of the DVT cases were HIV infected (HIV positive) while 21 cases(20.6%) were HIV negative. Among the other risk factors for DVT considered, 42(41.2%) of the DVT cases were also on treatment for Tuberculosis. Only a small percentage of the DVT cases had co morbidities like obesity,smoking,cancer,diabetes, immobility, kidney disease etc.It was found that 70(68.6%) of DVT cases were < 40yrs of age. Among patients with known CD4 counts, 29(70.7%) had a CD4 count<200 while 12 (29.3%) had a CD4 count ≥ 200. In univariate analysis, HIV (OR = 11.571;95% CI = 4.888 – 27.392) and TB (OR = 1.667.CI = 1.420 – 1.956) had significant association with DVT.When subjected to multiple logistic regression, only HIV (OR = 13.2, 95% CI = 5.3 – 32.3;p = <0.0001) and Age < 40yrs (OR = 2.7, 95%CI = 1.1 – 6.7; p = 0.034) were statistically significantly associated with DVT.A total of 650 HIV related cases were admitted over the same year period which gave a cumulative period prevalence of DVT of 12.5% among the HIV infected population. Conclusion: The prevalence of DVT at the Nelson Mandela hospital Mthatha was 12.5% for the year 2009 and is clearly above the average reported in other studies. HIV infection and age were the risk factors with a statistically significant association with DVT in this study. As this was an observational cross-sectional study, a more definitive prospective longitudinal design would assist in establishing the incidence of DVT in HIV infected patients, as well as the magnitude of the relationship between HIV and DVT.
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