Trends in pulmonary embolism in patients infected with HIV during the combination antiretroviral therapy era in Spain: A nationwide population-based study

Alejandro Alvaro-Meca,Juan Berenguer,Dariela Micheloud,Salvador Resino,Angel De Miguel,Pablo Ryan

doi:10.1038/s41598-018-29739-2

Abstract

Chronic infections are a major factor in the development of pulmonary embolism (PE). We aimed to evaluate the trends of PE-related hospitalizations and PE-related deaths in people living with HIV (PLWH) during the era of combination antiretroviral therapy (cART) through a retrospective study in Spain. Data were collected from the Minimum Basic Data Set (MBDS) between 1997 and 2013. The study period was fragmented into four calendar periods (1997–1999, 2000–2003, 2004–2007, and 2008–2013). The rate of PE-related hospitalizations remained stable in PLWH (P = 0.361). HIV-monoinfected patients had a higher incidence than HIV/HCV-coinfected patients during all follow-up [(98.7 (95%CI = 92.2; 105.1); P < 0.001], but PE incidence decreased in HIV-monoinfected patients (P < 0.001) and increased in HIV/HCV-coinfected patients (P < 0.001). Concretely, the rate of PE-related hospitalizations decreased significantly in patients monoinfected with HIV [from 203.6 (95%CI = 175.7; 231.6) events per 100,000 patient-years in 1997–1999 to 74.3 (95%CI = 66.1; 82.3) in 2008–2013; P < 0.001], while patients coinfected with HIV/HCV had a significant increase [from 16.3 (95%CI = 11; 21.6) in 1997–1999 to 53.3 (95%CI = 45.9; 60.6) in 2008–2013; P < 0.001]. The mortality rate of PE-related hospitalizations showed a similar trend as PE incidence. In conclusion, the epidemiological trends of PE in PLWH changed during the cART era, with decreases in incidence and mortality in HIV-monoinfected and increases in both variables in patients coinfected with HIV/HCV.

Highlights

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections overlap in both modes of transmission and affected populations
The incidences of hospitalizations related to Pulmonary embolism (PE) during the four study periods in HIV-infected patients are displayed in Fig. 1
The mortality rate of PE-related hospitalizations increased in patients coinfected with HIV/HCV [from 1.8 (95%CI = 0; 3.5) in 1997–1999 to 8.7 (95%CI = 5.8; 11.7) in 2008–2013; P = 0.002]

Summary

Introduction

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections overlap in both modes of transmission and affected populations. In Spain, the current prevalence of HIV-infected patients with HCV antibodies and active HCV infection is 37.7% and 22.1%, respectively. This is significantly lower than the prevalences recorded in 2002 and 20092. HIV infection is currently a manageable chronic disease in high-income countries since the introduction of combination antiretroviral therapy (cART)[3]. Patients infected with HIV are living long enough to face significant morbidity from chronic illnesses such as cardiovascular disease[4,5]. Chronic hepatitis C has become significant comorbidity in HIV-infected subjects with HCV infection and seems to have a negative impact on the clinical course of HIV-infected patients, since it increases both HIV-associated mortality and overall mortality[6,7]. Chronic infections can act as a trigger factor by inducing immune activation, synthesis of hepatic proteins associated with inflammation, and modification of the fibrinolysis and coagulation pathways[11]

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