Persistent B19 Parvovirus Infection in Patients Infected with Human Immunodeficiency Virus Type 1 (HIV-1): A Treatable Cause of Anemia in AIDS

Frickhofen, Norbert; Abkowitz, Janis L.; Safford, Monika M.; Berry, J. Michael; Antunez-de-Mayolo, Jorge; Astrow, Alan B.; Cohen, Robert M.; Halperin, Ira; King, Lambert N.; Mintzer, David M.; Cohen, B. J.; Young, Neal S.

doi:10.7326/0003-4819-113-12-926

Cited by 435 publications

(239 citation statements)

References 27 publications

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“…This propensity to develop protracted B19V viraemias in HIV-infected and other immunosuppressed individuals was described long ago (Kurtzman et al 1989b, Weiland et al 1989, Frickhofen et al. 1990, Gyllensten et al 1994).…”

Section: Discussionmentioning

confidence: 88%

“…These long intervals made it difficult to precisely know the time of B19V seroconversion and they prevented complete analysis of the interactions between serological (especially IgM) and molecular markers. Another limitation was not performing quantitative PCR (qPCR), as it is known that the virus may persist for a long time and maintain persistent viraemias in HIV-positive patients (Frickhofen et al 1990, Miao et al 2012). However, the following evidence of primary infections in our patients was found: (i) the previous serum samples (in relation to the PCR-positive samples) were negative by PCR, (ii) the subsequent samples (in relation to the PCR-positive samples) were also negative by PCR, (iii) seroconversions were observed in four of the five cases and (iv) all but one case occurred during an outbreak of B19V infection in Niterói.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients

Pereira

Garcia

Azevedo

et al. 2014

Mem. Inst. Oswaldo Cruz

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Immunocompromised patients may develop severe chronic anaemia when infected by human parvovirus B19 (B19V). However, this is not the case in human immunodeficiency virus (HIV)-infected patients with good adherence to highly active antiretroviral treatment (HAART). In this study, we investigated the clinical evolution of five HIV-infected patients receiving HAART who had B19V infections confirmed by serum polymerase chain reaction. Four of the patients were infected with genotype 1a strains and the remaining patient was infected with a genotype 3b strain. Anaemia was detected in three of the patients, but all patients recovered without requiring immunoglobulin and/or blood transfusions. In all cases, the attending physicians did not suspect the B19V infections. There was no apparent relationship between the infecting genotype and the clinical course. In the HAART era, B19V infections in HIV-positive patients may be limited, subtle or unapparent.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients

Pereira

Garcia

Azevedo

et al. 2014

Mem. Inst. Oswaldo Cruz

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“…However, it has also been implicated in a number of diseases. On one hand, in the immuno competent host, it causes Fifth disease in children and arthropathy in adults [1]; on the other hand, in the immuno compromised, it leads to pure red cell aplasia resulting in severe anemia requiring transfusions [2,3]. In patients with chronic haemolytic anemia such as sickle cell anemia, acute infection with this virus results in transient aplastic crisis owing to reticulocytopenia in the background of short erythrocyte survival [4].…”

Section: Introductionmentioning

confidence: 99%

Acute Parvovirus B19 Infection Leading to Severe Aplastic Anemia in a Previously Healthy Adult Female

Rajput¹,

Sehgal²,

Jain³

et al. 2011

Indian J Hematol Blood Transfus

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Human Parvovirus B19 has been linked to a variety of diseases. One of the most common complications is transient aplastic crisis in patients with chronic hemolytic anemia. Very few case reports have implicated this virus as a putative etiology behind hepatitis and severe aplastic anemia in immuno competent individuals. We report a case of severe aplastic anemia in a previously healthy adult female due to acute parvovirus B19 infection. Laboratory examination showed pancytopenia in peripheral blood and severe hypoplastic bone marrow on biopsy. Serological analysis (ELISA) revealed acute Parvovirus B19 infection. In the face of unavailable HLA matched bone marrow donor, immuno-supressive therapy was contemplated, but could not be given because of financial constraints. Pancytopenia persists till date, 4 months after the diagnosis, with the patient requiring repeated packed red cell and irradiated platelet transfusions. Thus, acute infection with this virus must be considered a cause of acquired aplastic anemia even in individuals without underlying disease.

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“…Its resolution after immune reconstitution due to highly active anti-retroviral therapy (HAART) was described recently (Scapellato et al 2000, Chen et al 2001, Nolan et al 2003. Immunoglobulin treatment can cure the infection and, sometimes and paradoxically, transiently worsen the clinical picture by triggering immune complex symptoms (Frickhofen et al 1990, Setúbal et al 2003, Young & Brown 2004). Since 1998 we have been studying erythrovirus B19 infection in our HIV infected patients in Hospital Universitário Antônio Pedro (HUAP), Niterói, Rio de Janeiro, Brazil (Aguiar et al 2001, Setúbal et al 2003.…”

mentioning

confidence: 99%

“…Examination of HE bone marrow biopsy specimens for "lantern cells" and/or bone marrow aspirate smears for giant pronormoblasts were also mentioned by these authors, but most times not recommended as a useful diagnostic method. Frickhofen et al (1990) published an account of seven AIDS patients with erythrovirus B19 infection and pure erythrocytic anemia. The diagnosis was confirmed in all seven patients through serum dot-blot hybridization.…”

mentioning

confidence: 99%

Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization

Setúbal

Oliveira

Pires

et al. 2006

Mem. Inst. Oswaldo Cruz

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Erythrovirus B19 infects erythrocytic progenitors, transiently interrupting erythropoiesis. In AIDS patients it causes chronic anemia amenable to treatment. We looked for evidences of B19 infection in stored bone marrow material from patients with acquired immunodeficiency syndrome. Histological sections were made from stored paraffin blocks from 33 autopsies (39 blocks) and 35 biopsies (45 blocks, 30 patients) performed from 1988 to 2002. They were examined after hematoxylin-eosin (HE) staining, immunohistochemical (IHC), and in situ hybridization. HE revealed intra-nuclear inclusion bodies ("lantern cells") suggesting B19 infection in 19 sections corresponding to 19 of 63 patients examined with this test. Seven of 78 sections subjected to immunohistochemistry were positive, corresponding to 7 of 58 patients examined with this test. Fourteen sections corresponding to 13 of the 20 HE and/or IHC positive patients were subjected to in situ hybridization, with six positives results. Among the 13 patients subjected to the three techniques, only one gave unequivocal positive results in all and was considered a true positive. The frequency of B19 infection (1/63 patients) in the material examined can be deemed low.Key words: parvovirus B19-anemia -chronic-immunodeficiency Erythrovirus B19 infects human erythrocytic progenitor cells, leading to a transient interruption of erythropoiesis. In the immunocompetent host this viral infection is cleared within two weeks as a result of the appearance of serum specific antibodies, and the hematological manifestations are restricted to a slight and asymptomatic decline in the hemoglobin levels. When the antibodies appear there may be symptoms of immune complex disease like arthralgias and exanthema. This is what normally takes place during the common childhood exanthematic disease erythema infectiosum. The course can be quite different in certain kinds of host, like those with hereditary hemolytic anemias (e.g., sickle-cell anemia), in whom an acceptable hematocrit is maintained only through an intense and uninterrupted bone marrow activity. In this context erythrovirus B19 infection usually leads to the rapid onset of a life threatening acute anemia, the so called "transient aplastic crisis". The patient is transfusion-dependent until the appearance of specific antibodies spontaneously clears the infection. A similar situation can be found in the fetus, where normal erythron volume expansion also demands a high activity of the hematopoietic fetal tissues. The sudden interruption of hematopoiesis leads to fetal heart failure and anasarca (hydrops fetalis), which may result in fetal death. In immunocompromised individuals (e.g., HIV-infected patients) erythrovirus infection is not readily cleared and its long persistence leads to chronic anemia. In these patients, intravenous standard immunoglobulin infusions usually end viremia and restore hematopoiesis (de Mayolo & Temple 1990, Mitchell et al. 1990, Gottlieb & Deutsch 1992, Noronha et al. 2005.Erythrovirus B19 was discovered by...

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Persistent B19 Parvovirus Infection in Patients Infected with Human Immunodeficiency Virus Type 1 (HIV-1): A Treatable Cause of Anemia in AIDS

Cited by 435 publications

References 27 publications

Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients

Clinical features and laboratory findings of human parvovirus B19 in human immunodeficiency virus-infected patients

Acute Parvovirus B19 Infection Leading to Severe Aplastic Anemia in a Previously Healthy Adult Female

Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization

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