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Pulmonary Vascular Disease |

The Unique Dynamics of Venous Thromboembolism in the Presence of HIV in a Rural, Resource-Constrained Setting in Western Kenya

Collins Saina; Imran Manji, BScPharm; Sonak Pastakia*, MPH; Rakhi Karwa, PharmD; John Kanyi, BScPharm
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Moi Teaching and Referral Hospital (MTRH) - Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya


Chest. 2012;142(4_MeetingAbstracts):860A. doi:10.1378/chest.1387462
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Abstract

SESSION TYPE: DVT/PE

PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Epidemiological studies have consistently illustrated that infection with HIV is a significant risk factor for the development of venous thromboembolism (VTE). Despite this evidence, very little data exists to describe the clinical consequences of the unique interplay between HIV and VTE. Through the Academic Model Providing Access to Healthcare (AMPATH), we have developed an anticoagulation monitoring service (AMS) to assist patients in western Kenya. AMPATH represents one of the largest providers of HIV care in Sub-Saharan Africa, providing comprehensive HIV services for over 140,000 ever-enrolled patients. The objective of this study is to highlight the distinctive dynamics of managing VTE in the presence of HIV and to provide guidance on the best strategies to mitigate recurrent VTE.

METHODS: The retrospective analysis assessed all patients who required anticoagulation monitoring since its inception. Patients were included in the analysis if they were HIV-infected, had a diagnosis of VTE, and were enrolled in the AMS. The preliminary analysis assessed the duration of therapy provided and the frequency and time course of unresolved or recurrent VTE.

RESULTS: Out of the 480 patients who required anticoagulation care, 90 patients met the inclusion criteria. The median duration of clinic follow-up was 195 days. Twenty-four (27%) of the eligible patients had evidence of unresolved VTE at the end of the intended treatment duration and required extended treatment. Two of the 90 patients had a recurrence of VTE 14 to 18 months after stopping therapy. Other factors affecting therapeutic efficacy included irregular attendance to clinic due to lack of funds and irregular international normalized ratios due to drug-drug interactions with warfarin.

CONCLUSIONS: The analyis reveals an unexpectedly high risk of prolonged VTE in the presence of HIV.

CLINICAL IMPLICATIONS: Although six months of anticoagulation therapy was chosen as the preferred duration of therapy by the AMS based on the limited evidence available, this analysis suggests that HIV-infected patients may require longer durations of warfarin for treatment of VTE.

DISCLOSURE: The following authors have nothing to disclose: Collins Saina, Imran Manji, Sonak Pastakia, Rakhi Karwa, John Kanyi

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Moi Teaching and Referral Hospital (MTRH) - Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya

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