the incidence of vascular complications of injecting illicit drugs is growing due to the new kinds of drugs and diverse way of consumption .
these facts have contributed to the increasing risk of venous thromboembolism.[24 ] moreover , patients with hiv / aids have more frequent episodes of deep venous thrombosis ( dvt ) than the general population .
preventive measures against venous thrombosis must involve a higher awareness about hiv / aids and the risks associated with intravenous drug use ( ivdu ) .
we report a patient with ivdu and hiv / aids who developed recurrent venous thromboembolism associated with injections in vessels of lower limbs and groin regions .
a 44-year - old female was admitted because of an insidious edema in the right lower limb , associated with moderate local pain , with 2 days of evolution .
she denied any antecedent of trauma and related that three similar episodes had occurred during the last 18 months .
her diagnosis of hiv-1 infection and aids was established in 2000 , and she was in regular use of efavirenz ( 600 mg / day ) plus lamivudine ( 150 mg / day ) and zidovudine ( 600 mg / day ) .
she was cigarette smoker ( pack - year : 15 ) and has been in use of injecting cocaine for 12 years , in addition to smoke crack , marijuana , and paste of cocaine for about 6 years .
admission examination showed body mass index ( bmi ) : 19.4 kg / m , edema in the right leg , moderate pain on palpation of the right thigh and right calf , and an abscess in the dorsum of the right foot .
doppler ultrasound scan ( uss ) showed thrombosis with signs of recanalization in right popliteal vein [ figure 1a ] and calcified thrombi in the right common femoral vein and in the superficial femoral vein [ figure 1b ] .
blood determinations of a 44-year - old woman hiv positive and injecting drug user presenting recurrent venous thrombosis ( a ) thrombus in the right popliteal vein with signs of recanalization ; ( b ) calcifi ed thrombus in the right superfi cial femoral vein
although this middle - aged and ivdu woman had been under antiretroviral treatment and presented three events of dvt ( 2008 , 2009 , and 2010 ) , thromboprophylaxis was not done .
her diagnosis of recurrent dvt was characterized by clinical data and comparative imaging studies by uss , and a full anticoagulation schedule was utilized with success .
complications related with ivdu may affect veins , arteries , and lymphatic vessels , including ischemia and pseudoaneurism due to intraarterial injection , vasculitis , artery dissection , arterial - venous fistulae , compartment syndrome , dvt , thromboflebitis , soft - tissue infections , bacteraemia , and sepsis.[246 ] recently , low serum levels of the c and s proteins and high levels of homocysteine were reported by basavanagowdappa et al . in a 27-year - old indian male with hiv infection and normal cd4 .
although the involved mechanisms are not entirely clear , hiv is an independent risk factor for venous thrombosis .
the prothrombotic state observed in hiv - infected patients has been associated with antiphospholipid antibodies , aspartyl protease , endothelial and platelet activation , low levels of c and s proteins , and lupus anticoagulant.[57 ] in spite of controversies , the highly active antiretroviral therapy and protease inhibitors may cause thromboembolic events . the risk of thrombosis can increase in patients with aids due to systemic inflammatory response and comorbidities such as immobility , infections , and malignancies.[47 ]
cooke and fletcher reviewed the data about dvt among 109 patients in england ; 33 of the ivdu group and 76 of the non - ivdu group ( median ages were 29 and 51 years , respectively ) .
although the exact rate of recurrences could not be monitored , the recurrent dvts were more frequent in patients from the ivdu group .
one possible explanation was the shorter duration of anticoagulation to avoid hemorrhagic events in this group of patients .
irish et al . reviewed data from the united kingdom department of health about skin , soft tissue , and vascular complications among drug users and found a conspicuous increase in hospitalization .
they emphasized the role of injections in femoral vessels ( groin injecting ) , which may cause superficial phlebitis , dvt , and arterial pseudoaneurisms in lower limbs .
saber et al . reviewed data of 45 patients in new york with hiv / aids and dvts in the lower limbs and found recurrent episodes of thrombosis in 26.7% of the cases .
the patient 's mean age was 43 years and 55.5% of the dvts had caused femoral or iliofemoral obstructions .
the authors concluded that hiv / aids constitutes a main risk factor for dvts in lower limbs , and this condition occurs near 10 times more often than in general population .
preventive measures against dvt should include higher awareness about the prothrombotic risks of hiv / aids and ivdu ; subcutaneous , intramuscular , and groin injecting should be avoided by drug users ; and accurate examination of the lower limbs must be routinely performed in all patients with antecedent of ivdu in primary care setting . with limitations inherent to a single case study , this report may contribute to increase the awareness about the higher tendency to venous thromboses among drug users and hiv - infected individuals .
 we report a case of recurrent deep venous thrombosis in a 44-year - old woman , intravenous drug user and hiv - infected , who injected cocaine in the groins and veins of the dorsum of the feet . 
 she suffered several episodes of deep venous thrombosis and soft - tissue infections in the lower limbs . 
 images of doppler ultrasound scan revealed thrombosis in the right popliteal vein with partial recanalization and calcified thrombi in the territory of the right femoral vein . 
 after use of heparin and oral anticoagulation , her clinical evolution was uneventful , and she was asymptomatic at the occasion of the hospital discharge . this report calls for better awareness about injections in the groins and superficial femoral veins , which are part of the deep venous system . 
 thrombosis related to hiv infection is highlighted . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION