Thrombocytopenia in HIV patients coinfected with tuberculosis

Abstract

Thrombocytopenia is one of the most common hematological manifestations seen in HIV patients with approximately 40% of the patients developing thrombocytopenia during their course of illness. Opportunistic infection like tuberculosis is a rare but curative cause of thrombocytopenia in these patients. Clinically, it is a challenge to determine the exact cause and decide the treatment of thrombocytopenia in these patients as both infections can lead to significant thrombocytopenia by varied mechanisms. The treatment options are limited by drug antitubercular treatment highly active antiretroviral therapy (ATT and HAART)-induced thrombocytopenia. A 25-year-old male patient presented with low grade, intermittent fever with left-sided pleuritic chest pain for 2 months along with dry cough, weight loss, malaise, and lethargy. Hematological examination showed anemia, leukopenia, and thrombocytopenia. The patient was found to be HIV reactive. Chest X-ray revealed nonhomogenous opacity with cavitation in the left upper and middle zone suggestive of tuberculosis. He received multiple units of blood and platelets and was started on isoniazid, rifampicin, pyrazinamide, and ethambutol. HAART was initiated 2 weeks after starting ATT. Patient's hematological parameters improved and he was discharged on ATT and HAART with recovery of the platelet counts. Thrombocytopenia is a complication associated with both HIV and tuberculosis and hence determining the cause and deciding the appropriate treatment is challenging. Decision about whom and when to treat has to be taken cautiously considering all possible contributors and treatment has to be individualized.

Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

“…Thrombocytopenia was observed in 1.6% of the cases in the current study. The most common reasons being thrombocytopenia was, peripheral destruction of platelets due to cross-reactivity of HIV antibodies, apoptosis of megakaryocytes due to direct HIV infection and abnormal and dysfunctional platelet production [ 54 ]. The prevalence was similar with a finding reported by Oshikoya et al [ 55 ] found to be 1.4%.…”

Hematological Abnormalities of Pulmonary Tuberculosis Patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: A Comparative Cross-Sectional Study

“…The prevalence of thrombocytopenia among PTB patients was 8% while it was 20% among PTB-HIV coinfected patients. Different mechanisms such as immune mechanisms, bone marrow fibrosis, direct megakaryocyte infection, and hypersplenism had been implicated as possible causal factors for thrombocytopenia in PTB-HIV coinfected patients [36–40].…”

The dilemma in a case of immune thrombocytopenia in a patient with human immunodeficiency virus on antituberculosis treatment for miliary pulmonary tuberculosis

“…In primary thrombocytopenia, the causes differ in different stages of HIV, where autoimmune destruction predominates in early stages, while defective thrombopoiesis predominates in the late stages [1]. In secondary thrombocytopenia, opportunistic infections are important causes and TB is the most common [2,4,5].…”