Epidemiological trends of deep venous thrombosis in HIV-infected subjects (1997-2013): A nationwide population-based study in Spain

Background: Chronic infections may be a triggering factor as well as a risk factor of deep venous thrombosis (DVT). The purpose of this study was to analyze the epidemiological trends of hospital admissions related to DVT in human immunodeficiency virus (HIV)-infected patients during the combination antiretroviral therapy (cART) era, in relation to hepatitis C virus (HCV) serological status. Methods: We performed a retrospective study using the Spanish Minimum Basic Data Set. We selected HIV-infected subjects over 15 years old with a hospital admission and DVT diagnosis (ICD-9-CM codes: 453.4x and 453.8x) between 1997 and 2013. Patients were classified according to HCV serology. We estimated the incidence (events per 100,000 patient-years) in four calendar periods (1997-1999, 2000-2003, 2004-2007, and 2008-2013). Results: Overall, the incidence of DVT-related hospitalizations had a significant upward trend in all HIV-infected patients (P < 0.001), with significant differences between 1997-1999 and 2008-2013 [49.5 vs. 88.1 (P < 0.001)]. Moreover, the incidence was higher in HIV-monoinfected patients than in HIV/HCV-coinfected patients during the entire follow-up (P < 0.001). However, the incidence had a significant downward trend in HIV-monoinfected patients (P = 0.002) and a significant upward trend in HIV/HCV-coinfected patients (P < 0.001). Specifically, the incidence of DVT-related hospitalizations in HIV-monoinfected patients significantly decreased from 1997-1999 to 2008-2013 [142.7 vs. 103.1 (P = 0.006)], whereas in HIV/HCV-coinfected patients, the incidence increased from 8.4 (1997-1999) to 70.7 (2008-2013) (P < 0.001). Conclusions: Our findings suggest that DVT is an emerging health problem among HIV-infected patients, with increasing incidence during the first 17 years after the introduction of cART, particularly in HIV/HCV-coinfected patients.