Thrombose Veineuse des Membres Inférieurs chez les Personnes Vivant avec le VIH : Étude de 33 Cas au CHU du Point G

RESUME Introduction. Les manifestations thrombo-emboliques sont de plus en plus frequentes chez les patients vivant avec le VIH. L’objectif de ce travail etait de decrire les aspects cliniques, therapeutiques et evolutifs des thromboses veineuses des membres inferieurs chez cette categorie de patients. Patients et methodes. Il s’agit d’une etude retrospective descriptive allant de janvier 2014 a decembre 2016. Les dossiers des patients infectes par le VIH hospitalises, dont le diagnostic de thrombose veineuse des membres inferieurs a ete confirme par l’echographie-Doppler ont ete analyses. Les donnees ont ete collectees dans la stricte confidentialite. Resultats. Trente trois (33) patients ont ete etudies dont 22 de sexe feminin (66,7%). Leur âge moyen etait de 33.9 ans. L’immunodepression cellulaire etait severe (CD4 ˂200/mm3) chez 63,6 % des patients. 18 (54.5%) patients etaient sous traitement antiretroviral de premiere ligne a base de deux inhibiteurs nucleosidiques de la transcriptase inverse associes a un inhibiteur non nucleosidique de la transcriptase inverse. La tuberculose pulmonaire (30,3%), la toxoplasmose cerebrale (15,1%) et la cryptococcose neuromeningee (6%) etaient les principales affections opportunistes associees. Les thromboses siegeaient principalement dans la veine femorale (39,4%). Des localisations multiples ont ete observees dans neuf cas (27.3%). Malgre l’anticoagulation dont tous les patients ont beneficie, la mortalite a ete de 45,4% (15 patients). Conclusion. Les thromboses veineuses des membres inferieurs sont une realite chez les patients vivant avec le VIH hospitalises. Elles sont associees a une mortalite importante. ABSTRACT Introduction. The prevalence of lower limb deep venous thrombosis is increasingly in patients living with HIV. The objective of our work was to describe clinical features, treatment and outcome of lower limb deep venous thrombosis in patients living with HIV. Patients and methods. This was a cross sectional descriptive retrospective study that took place from January 2014 to December 2016. The files of hospitalized HIV-infected patients, whose diagnosis of venous thrombosis of the lower limbs was confirmed by doppler ultrasound were analyzed. The data were managed in strict confidentiality. Results. Thirty three (33) patients were studied, 22 of whom were female (66.7%). Their mean age was 33.9 years. Cellular immunosuppression was severe (CD4 ˂200 / mm3) in 63.6% of patients. Eighteen patients (54.5%) patients were on first-line antiretroviral therapy consisting of two nucleoside reverse transcriptase inhibitors combined with a non-nucleoside reverse transcriptase inhibitor. Pulmonary tube  rculosis (30.3%), cerebral toxoplasmosis (15.1%) and neuromeningeal cryptococcosis (6%) were the main associated opportunistic conditions. The thrombus was mainly located in the femoral vein (39.4%). Multiple locations were present in nine patients (27.3%). Despite the anticoagulation that was administered to all patients, mortality was 45.4% (15 patients). Conclusion. Lower limb deep venous thrombosis is a common in hospitalized patients living with HIV in Bamako. It is associated to significant mortality.