Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era

Abstract

The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 109/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6%) had an ITP diagnosis and platelet count <20 × 109/L. Initial ITP treatment included IVIG, n = 12; steroids, n = 10; anti-RhD, n = 8; HAART, n = 3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71%) required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.

Prevalence and associated factors of thrombocytopenia among human immunodeficiency virus-infected patients at a tertiary care hospital in İzmir, Turkey

“…In this study, when all patients were included, the overall rates were 35.8%, 24.2%, and 10.5% for platelet count of <150,000/ µL, <100,000/µL, and <50,000/µL, respectively. These rates were higher than in earlier reports (19,30,31). Differences among studies might be related to the differences in the definition of thrombocytopenia or the heterogeneity of the study population, or racial factors.…”

Thrombocytopenia during pregnancy in women with HIV infection receiving no treatment

“…While other studies have reported a relationship between the severity of the HIV infection and the occurrence or severity of TCP, [7] this was not confirmed in the present study. Ambler et al [15] documented similar findings in a population of highly active antiretroviral therapy (HAART) recipients.…”

Only severe thrombocytopenia results in bleeding and defective thrombus formation in mice

“…[11][12][13] Generally, medical treatment of thrombocytopenia with functional platelets is indicated in adult patients with a platelet count of ,30 platelets/nL blood. [14][15][16][17] However, it is widely accepted that the decision to treat thrombocytopenia should not entirely be based on the PC, but rather made in the context of clinical symptoms and disease progression. 16,18 Indeed, studies in humans have shown that the bleeding risk at reduced PCs is influenced by the individual's age, 19,20 the occurrence of trauma, 21 genetic susceptibility, environmental effects, medication, or comorbidity.…”