Pure Red Cell Aplasia Induced by Lamivudine without the Influence of Zidovudine in a Patient Infected with Human Immunodeficiency Virus

Nakamura, Kiwamu; Tateyama, Masao; Tasato, Daisuke; Haranaga, Shusaku; Tamayose, Maki; Yara, Satomi; Higa, Futoshi; Fujita, Jiro

doi:10.2169/internalmedicine.53.2460

Cited by 10 publications

(5 citation statements)

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“…2,3,6 In addition to combination formulations, previously there were also single medication formulations available for use in NSARTs. A remaining shortfall of the current 2014 guidelines exists in the extremely rare situation of lamivudine toxicity, most commonly manifested as red cell aplasia, 7 or in patients with renal failure, for whom NRTI dose reductions may not be possible with fixed-dose combinations. In second- patient was initially maintained on this regimen.…”

Section: Discussionmentioning

confidence: 99%

Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi

et al. 2016

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AimLighthouse Trust in Lilongwe, Malawi serves approximately 25,000 patients with HIV antiretroviral therapy (ART) regimens standardized according to national treatment guidelines. However, as a referral centre for complex cases, Lighthouse Trust occasionally treats patients with non-standard ART regimens (NS-ART) that deviate from the treatment guidelines. We evaluated factors contributing to the use of NS-ART and whether patients could transition to standard regimens. MethodsThis was a cross-sectional study of all adult patients at Lighthouse Trust being treated with NS-ART as of February 2012. Patients were identified using the electronic data system. Medical charts were reviewed and descriptive statistics were obtained. ResultsOne hundred six patients were initially found being treated with NS-ART, and 92 adult patients were confirmed to be on NS-ART after review. Mean patient age was 42.4 ± 10.3 years, and 52 (57%) were female. Mean duration of treatment with the NS-ART being used at the time of data collection was 2.1 ± 1.5 years. Eight patients (9%) were on modified first-line NS-ART and 84 (91%) were on modified second-line NS-ART, with 90 patients (98%) having multiple factors contributing to NS-ART use. Severe toxicity from one medication contributed in 28 cases (30%) and toxicity from multiple medications contributed in 46 cases (50%), while 22 patients (24%) were transitioned to NS-ART following a stockout of their original medication. Following clinical review, 84 patients (91%) were transitioned to standard regimens, and eight (9%) were maintained on NS-ART because of incompatibility of their clinical features with the latest national guidelines. ConclusionsPrimary factors contributing to NS-ART use were medication toxicities and medication stockouts. Most patients were transitioned to standard regimens, although the need for NS-ART remains.

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Section: Discussionmentioning

confidence: 99%

Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi

et al. 2016

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“…A multitude of factors, such as sex, low nutritional status, anti-tuberculosis treatment (ATT), opportunistic infections, an advanced stage of the HIV disease, a CD4 + count below 200 cells/microliter, a white blood cell (WBC) count below 4000 cells/microliter, and a platelet count below 200,000 cells/microliter, as well as zidovudine-containing ART regimens, have been identified to be associated with anemia among HIVaffected individuals [8,4,[13][14][15][16]. Pure red cell aplasia, characterized by a normal leukocyte and platelet count, a corrected reticulocyte count below 1%, less than 5% of erythrocyte precursors in the bone marrow, and no hemolysis is an uncommon cause of refractory anemia in HIV/AIDS and occurs consequent to an autoimmune response selectively affecting erythroid cell lines or ART-induced myelosuppression [16][17][18]. However, the magnitude of these factors varies across regions depending upon socioeconomic and health conditions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of anemia among HIV-infected individuals and the associated factors: A single-center, retrospective review of 513 cases

Mahajan¹,

Dhattarwal²,

Mehta³

et al. 2023

Our Dermatol Online

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Background: Although a major public health problem around the world, the prevalence of anemia and the associated factors in HIV-infected individuals remains understudied in the Indian context. Objectives: The objective was to assess the prevalence of anemia and the associated factors among HIV-infected individuals. Methods: The records of 513 HIV-affected individuals (M: F: 244:269) aged 12 to 84 years (mean ± SD: 37.5 ± 12.1) were reviewed retrospectively for the presence of anemia and the associated factors. The anemia was defined and severity was graded per the WHO guidelines. Results: Anemia of variable severity was present in 77.7% of the individuals. The female sex(OR: 2.09; Cl: 95%; CI: 1.41–3.10; p < 0.05), CD4+ count ≤ 200 cells/microliter (OR: 2.36; Cl: 95%; CI: 1.59–3.52; p < 0.0001), WBC count < 4000 cells/mm3 (OR: 3.29; Cl: 95%; CI: 0.97–11.14; p < 0.04), platelet count < 100,000 cells/dL (OR: 0.50; Cl: 95%; CI: 0.31–0.81; p < 0.05), before ART (OR: 3.78; Cl: 95%; CI: 2.91–4.91; p < 0.0001), and tuberculosis treatment (OR: 5.88; Cl: 95%; CI: 1.38–25.04; p < 0.05) were factors significantly associated with anemia. The mean duration of highly active antiretroviral therapy (ART) was 3.15 years, with 395 (77%) individuals being on treatment for ≤ five years. ART significantly improved hemoglobin levels (p < 0.0001). Conclusion: Anemia of variable severity remains a significant co-morbidity among HIV-infected individuals, especially females, prior to the initiation of ART, and those with a low CD4+ count or thrombocytopenia and on anti-tuberculosis treatment. The fact that this was a single-center study, its small number of subjects, the retrospective design, and no information on red blood cell indices and the viral load were its important limitations. Key words: AIDS; anemia; ART; CD4+ count; HAART; HIV; India

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“…In 1998, several case reports implicated 3TC as a cause of pure red cell aplasia (PRCA). 1 , 2 , 3 , 4 , 5 Initially, 3TC was thought to potentiate the haematological toxicity of AZT, following reports of two patients who presented with profound anaemia while on both drugs. 1 Later, 3TC was shown to cause anaemia independently of AZT.…”

Section: Introductionmentioning

confidence: 99%

A case series of emtricitabine-induced pure red cell aplasia

Manickchund

Plessis

et al. 2021

Southern African Journal of HIV Medicine

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Background: Anaemia is common in patients with retroviral disease. New or worsening anaemia after initiation of antiretroviral (ARV) treatment has a broad differential diagnosis.Objectives: We describe six patients who developed transfusion-dependent anaemia on first-line therapy (tenofovir, emtricitabine and efavirenz) and, by exclusion, implicated emtricitabine in the aetiology of the anaemia.Method: We conducted a retrospective chart review of patients seen at the Infectious Diseases specialist clinic at King Edward VIII Hospital in KwaZulu-Natal between 2014 and 2016. We focused on patients with isolated, refractory and transfusion-dependent anaemia occurring after initiation of ARVs, in whom bone marrow biopsies were consistent with pure red cell aplasia (PRCA) without an identifiable secondary cause.Results: All the patients were female, with a median (range) age and baseline CD4 cell count of 42.5 (23–61) years and 237 (83–329) cells/mm3, respectively. Before presenting with symptomatic anaemia, the duration on emtricitabine was 4.5 (2–8) months. At presentation, all patients had an HIV viral load of 1000 copies/mL and a CD4 cell count of 314 (213–389) cells/mm3. The median time to recovery following the discontinuation of emtricitabine was 2 (1–4) months. After a median of 12 months, all patients were successfully rechallenged with emtricitabine and remained well for a follow-up period of 24 (7–36) months.Conclusion: This study provides strong circumstantial evidence that emtricitabine plays an important role in the pathogenesis of reversible PRCA. The mechanisms through which emtricitabine induces PRCA remain unclear and require further study.

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Pure Red Cell Aplasia Induced by Lamivudine without the Influence of Zidovudine in a Patient Infected with Human Immunodeficiency Virus

Cited by 10 publications

References 14 publications

Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi

Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi

Prevalence of anemia among HIV-infected individuals and the associated factors: A single-center, retrospective review of 513 cases

A case series of emtricitabine-induced pure red cell aplasia

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