Pulmonary Vascular Disease |

Risk Factors for Pulmonary Embolism at Autopsy Among HIV Infected Patients FREE TO VIEW

Rosanna Setse, MD; Alicia Thomas, MD; Christelle Tchiendji, MD; Nandita Shetty, MBBS; Richard Gillum, MD; Wayne Davis, MD; Alvin Thomas Jr, MD; Alem Mehari, MD
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Department of Internal Medicine, Washington, DC

Chest. 2013;144(4_MeetingAbstracts):872A. doi:10.1378/chest.1704883
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SESSION TITLE: Pulmonary Embolism

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Advanced HIV disease is a risk factor for development of thromboses, possibly due to an increased inflammatory state or the presence of concurrent opportunistic infections. Others have suggested that HIV-related factors, rather than traditional risk factors may be more important in the pathogenesis of clot formation among HIV infected persons. Few studies have reported autopsy findings among HIV infected patients. Our goals were to describe autopsy findings among HIV infected patients died in metropolitan hospital in Washington D.C and examine correlates of venous thromboembolism (VTE) in this population.

METHODS: We reviewed the medical records and autopsy reports of 123 HIV infected patients deceased to between 1985-2000. Demographic data, risk factors for HIV transmission and relevant clinical diagnoses on admission were abstracted from patient’s medical records. Cause of death and pulmonary findings at autopsy were abstracted from autopsy reports. Baseline characteristics and autopsy findings were described using simple tables and frequencies. The association between thrombo-embolic events & opportunistic infections was examined using logistic regression analyses.

RESULTS: Of 123 deceased HIV infected patients who had autopsies performed between 1985 and 2000, 72.4% (n=89) were male and 98% (n=121) were African-Americans. The median age of participants was 38 years (range: 20 -71 years). Twenty-five percent (n=121) of patients had evidence of pulmonary thrombo-embolism and/or infarct at autopsy. Other histological findings at autopsy included pulmonary edema (88.6%), diffuse alveolar damage (51.2%), pneumonia (82.1%), and pleural effusion (61%). Sixty-eight (55.3%) of patients had at least 1 opportunistic infection. Patients with a documented diagnosis of Pneumocystis jiroveci pneumonia (PCP) and malignancy pre-mortem were more likely to have VTE at post-mortem [Adjusted Odds Ratio (AOR): 3.38, 95% CI (1.08-10.55) and AOR 3.70, 95%CI (1.26-10.83) respectively].

CONCLUSIONS: Pulmonary embolism was a common finding among HIV infected patients at autopsy. Opportunistic infections particularly PCP infection was independently associated with pulmonary embolism at autopsy.

CLINICAL IMPLICATIONS: Further studies are needed to elucidate the pathobiology and trend of VTE in the post HAART era.

DISCLOSURE: The following authors have nothing to disclose: Rosanna Setse, Alicia Thomas, Christelle Tchiendji, Nandita Shetty, Richard Gillum, Wayne Davis, Alvin Thomas Jr, Alem Mehari

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