Emtricitabine-induced pure red cell aplasia

Abstract

Introduction: Anemia is common in HIV. Parvo B19 infection is a well-recognised cause of red cell aplasia. Other causes of persistent pure red cell aplasia (PRCA) include anti-retroviral drugs such as zidovudine and lamivudine. We describe a case of PRCA that strongly implicates emtricitabine as the probable cause.Patient presentation: Patient was HIV positive and on treatment with a fixed drug combination consisting of tenofovir, emtricitabine and efavirenz for 3 months when she developed severe transfusion dependent anemia. The anemia, attributed to PRCA, was persistent and transfusion dependent for about one year.Management and outcome: Replacement of emtricitabine with abacavir resulted in a prompt, complete and lasting resolution of the anaemia, suggesting an etiologic role of emtricitabine in the PRCA.Conclusion: Emtricitibine is a rare cause of pure red cell aplasia.

A case series of emtricitabine-induced pure red cell aplasia

“…Patient 5 was previously published as a case report. 14 This patient’s persistent anaemia was initially thought to be the result of parvovirus B19 infection based on a positive parvovirus B19 PCR test. Despite multiple rounds of intravenous immunoglobulin and attaining an undetectable HIV viral load with significant recovery of the CD4 cell count from 83 cells/mm 3 to 237 cells/mm 3 , this patient remained transfusion dependent.…”