Outcomes of varicose vein surgery in patients with HIV/AIDS – a nested case-control study
DOI:
https://doi.org/10.48750/acv.492Keywords:
HIV/AIDS care, chronic venous disease, varicose veins, venous surgeryAbstract
INTRODUCTION: Currently, people living with HIV/ AIDS (PLWHA) attain a life expectancy similar to a non-HIV population. However, these patients experience a status of chronic inflammation, which is a known cause of arteriopathy. Yet, literature is scarce regarding the potential venous inflammatory effect, especially after varicose vein surgery. The aim of this study was to perform a descriptive analysis alongside evaluating short and long- term outcomes after varicose vein surgery in PLWHA while comparing with a control group.
METHODS: A retrospective nested case-control study was performed resorting to codification. All PLWHA patients which had any hospital interaction with the Vascular Surgery Department (either outpatient clinic, emergency or surgery) due to venous disease between April 2006 and December 2019 were identified. PLWHA found to have undergone varicose vein surgery within the study inclusion period were included. The immediately consecutive varicose vein surgery in a patient with no-HIV infection was included in the control group in a 1:1 ratio. Comorbidities were collected at the time of index event.
RESULTS: The cohort included 118 patients (59 PLWHA and 59 control) and had a mean follow-up of 86 [Interquartile range (IQR) 25-75%, 43-111] months. At baseline, PLWHA were younger (45.2 ± 10.71 vs 49.9 ± 10.69 years, p=0.017) and had a male predominance (54% vs 27%, p=0.003). Furthermore, there were a higher prevalence of smokers (54% vs 17%, p<0.001) and history of drug abuse (34% vs 2%, p<0.001) in the study group. Although not statistically significant, PLWHA presented higher pre-operative CEAP classifications. Regarding post-operative outcomes, no differences were found for complications, reinterventions or overall-mortality.
CONCLUSION: To the authors knowledge, this is the first study addressing varicose vein treatment in PLWHA. In summary, PLWHA undergoing varicose vein surgery seem to be younger and have higher CEAP classifications. Nonetheless, short and long-term outcomes seem to be good and similar to a control population. Further studies with larger populations and disease specific outcomes are necessary to confirm such findings.
Downloads
References
Rosenson RS, Hubbard D, Monda KL, Reading SR, Chen L, Dluzniewski PJ, et al. Excess Risk for Atherosclerotic Cardiovascular Outcomes Among US Adults With HIV in the Current Era. J Am Heart Assoc. 2020;9:e013744.
Palella FJ, Jr., Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853-60.
Weber R, Ruppik M, Rickenbach M, Spoerri A, Furrer H, Battegay M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Med. 2013;14:195-207.
Masia M, Padilla S, Garcia JA, Garcia-Abellan J, Fernandez M, Bernardino I, et al. Evolving understanding of cardiovascular, cerebrovascular and peripheral arterial disease in people living with HIV and role of novel biomarkers. A study of the Spanish CoRIS cohort, 2004-2015. PLoS One. 2019;14:e0215507.
Godoi ET, Brandt CT, Lacerda HR, Godoi JT, Oliveira DC, Costa GF, et al. Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals. Arq Bras Cardiol. 2017;108:3-11.
Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59:1787-97.
Msoka TF, Van Guilder GP, van Furth M, Smulders Y, Meek SJ, Bartlett JA, et al. The effect of HIV infection, antiretroviral therapy on carotid intima-media thickness: A systematic review and meta-analysis. Life Sci. 2019;235:116851.
Agrati C, Mazzotta V, Pinnetti C, Biava G, Bibas M. Venous thromboembolism in people living with HIV infection (PWH). Transl Res. 2021;227:89-99.
Zhang Q, Peng F, Li M, Yi Q, Tang W, Wu S. Elevated Risk of Venous Thromboembolism in People Living with HIV. Viruses 2022;14:590
Howard JFB, Rokx C, Smit C, Wit F, Pieterman ED, Meijer K, et al. Incidence of a first venous thrombotic event in people with HIV in the Netherlands: a retrospective cohort study. Lancet HIV. 2019;6:e173-e81.
Klein SK, Slim EJ, de Kruif MD, Keller TT, ten Cate H, van Gorp EC, et al. Is chronic HIV infection associated with venous thrombotic disease? A systematic review. Neth J Med. 2005;63:129-36.
Kendall CE, Wong J, Taljaard M, Glazier RH, Hogg W, Younger J, et al. A cross-sectional, population-based study measuring comorbidity among people living with HIV in Ontario. BMC Public Health. 2014;14:161.
Kilmarx PH. Global epidemiology of HIV. Curr Opin HIV AIDS. 2009;4:240-6.
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63:184-267.
