Thrombotic Microangiopathy and Cytomegalovirus Disease in Patients Infected with Human Immunodeficiency Virus

Abstract

Thrombotic microangiopathy (TMA) can occur during the course of human immunodeficiency virus (HIV) infection. Clinical and pathological data for 29 patients with TMA and HIV infection were recorded. In a retrospective case-control study, we analyzed the link between opportunistic infections or drug therapies and TMA. Twenty-five patients (mean CD4+ cell count +/- SD, 71.9 +/- 18.3/mm3) had renal impairment, and four had neurological dysfunction. In one-half the cases, the disease was progressive with isolated fragmentation anemia appearing several months before the clinical symptoms. The diagnosis of TMA was confirmed by histological examination of kidney biopsy specimens (18 cases). Endothelial cytomegalovirus (CMV) inclusions were associated with TMA in nine of 18 cases, whereas histological examination did not detect CMV in any control specimens (P < .001). The case-control study demonstrated a link between TMA and clinical CMV infection (odds ratio, 3.9; 95% confidence interval, 1.1-14). We conclude that TMA is a late complication of HIV infection and can be associated with systemic CMV infection in this setting.

Thrombotic microangiopathy associated with reactivation of human herpesvirus-6 following high-dose chemotherapy with autologous bone marrow transplantation in young children

“…22 Moreover, in patients with human immnodeficiency virus infection, TMA has been reported to be induced by CMV infection. 23 Endothelial CMV inclusions were confirmed by histological examination of the kidney in that study. Similarly, HHV-6 antigens were detected in the endothelial cells of small vessels in the brain in a patient with HHV-6 encephalitis.…”

HIV‐Associated Thrombotic Microangiopathy in the Era of Highly Active Antiretroviral Therapy: An Observational Study

“…TTP and adult HUS are considered part of a spectrum of diseases collectively known as "thrombotic microangiopathies" (TMA) because they have ognized in 1984 [27] and since then, both TTP and HUS have been reported in HIV-infected patients [28][29][30][31]. TMA in persons with HIV infection does not differ clinically from that in persons not infected with HIV and occurs regardless of the route of transmission of HIV [29], with advanced immunosuppression, opportunistic infections, and various drugs commonly used in advanced disease all considered to be potential risk factors [30][31][32][33]. Complete deficiency of the von Willebrand factor-cleaving protease has also been reported in HIV-associated TTP [34].…”

Acute cytomegalovirus infection and venous thrombosis: Role of antiphospholipid antibodies

“…3,8,9 In these cases the CMV infection is usually a reactivation. CMV is common in immunocompetent patients and generally either is asymptomatic or causes mononucleosis-like symptoms.…”