Thrombotic microangiopathy and retroviral infections: A 13‐year experience

Abstract

Eleven of fifty serum samples collected from patients with a diagnosis of thrombotic microangiopathy (TMA), from 1979 to 1991, tested positive for antiretroviral antibodies. Seven had human immunodeficiency virus (HIV) infection, and four had human lymphotrophic virus, type I (HTLV-I) infection. All patients were treated with plasma exchange and/or infusion, but only two of the HIV-infected patients obtained a complete response (CR) and one of them died after a few months. Combined results from the literature indicate that most patients with HIV infection survive less than one year from the initial diagnosis of TMA. In the setting of HIV infection, TMA is a treatable condition, but survival for most patients is less than 12 months. Three of the four HTLV-I infected patients with TMA had a CR. These observations strongly suggest that both HIV and HTLV-I infections are associated with TMA, but rigorous epidemiologic studies will be needed to determine the relative risk for each. Retroviral infections should be considered in patients with TMA, especially if the patient has associated risk factors and demographic characteristics.

Thrombotic Microangiopathy in the HIV-2-Infected Macaque

“…Several hundred cases of HIV-associated TMA have been reported in the literature, with particularly increased recognition during the last several years (reviewed in [2][3][4][5][6][7] ). Compared to several million HIV-1-infected humans worldwide, the percentage of TMA-affected HIV-1-positive patients might seem low.…”

“…[2][3][4][5][6][7] HIV-associated TMA lesions are characterized by occlusive thrombi in glomerular capillaries and small arteries, with no evidence of immune complex deposition as an underlying etiology. 40 We are the first to report the presence of renal TMA lesions in an animal model of HIV infection.…”

“…[2][3][4][5][6][7] HIV-associated nephropathy (HIVAN), characterized by focal and segmental glomerulosclerosis (FSGS) and a collapsing glomerulopathy, has been identified as the single most common cause of chronic renal insufficiency in HIV-infected humans. 8 -11 The TMA injury involves damage to the endothelial lining of glomerular capillaries and arterial microvessels, with activation of the plasma coagulation cascade, causing thromboses in these vessels.…”

Thrombotic microangiopathy following allogeneic bone marrow transplantation is associated with intensive graft-versus-host disease prophylaxis

“…2,3 Individuals infected with the human immunodeficiency virus have an increased incidence of TTP. 4 TM also occurs in relation to pregnancy; TTP tends to occur in the ante-partum period while HUS is more frequent post-partum. 1 Administration of chemotherapy, especially mitomycin C, has been associated with the development of HUS.…”

Intravenous Gamma Globulin in Refractory Thrombotic Thrombocytopenic Purpura

“…Among the various causes of TTP, viral infections have been reported [15] such as influenza virus, EBV, herpes simplex virus, mycoplasma, Coxsackie virus B, echovirus and more recently HIV, above all in the ad vanced stage of the disease [16,17], In our patient, viral infections, influenza and rubella, preceded the relapses and perhaps triggered them. The possible viral etiology in our case could also explain the efficacy of HDIg, which are commonly used to prevent or reduce viral infections in immunocompromised patients.…”