Acquired haemophilia A associated with HIV infection

Rivoisy, Claire; d'Oiron, R; Cherin, Melanie; Ségéral, Olivier; Meynard, Jean-Luc; Lambert, Thierry; Goujard, Cécile

doi:10.1097/qad.0000000000000172

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…The incidence of acquired haemophilia due to circulating antibodies against clotting factors in PLWHA is mostly anecdotal with only a few case reports describing patients with HIV infection and factor VIII inhibitors either in the backdrop of HCV co‐infection, pre‐existing haemophilia, or in the context of cART and immune reconstitution inflammatory syndrome (Zeichner et al , ; Rivoisy et al , ). Both B‐ and T‐ cell immune dysregulation may predispose to the development of such autoantibodies (Franchini & Lippi, ).…”

Section: Epidemiology Diagnosis and Treatment Of Haematological Abnomentioning

confidence: 99%

Haematological manifestations of human immune deficiency virus infection

Vishnu

Aboulafia

2015

Br J Haematol

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SummaryEarly in the human immunodeficiency virus (HIV) epidemic, infected patients presented to medical attention with striking abnormalities in each of the major blood cell lineages. The reasons for these derangements remain complex and multifactorial. HIV infects multipotent haematopoietic progenitor cells and establish latent cellular reservoirs, disturbs the bone marrow microenvironment and also causes immune dysregulation. These events lead to cytokine imbalances and disruption of other factors required for normal haematopoiesis. Activation of the reticulo-endothelial system can also result in increased blood cell destruction. The deleterious effects of medications, including first and second generation anti-retroviral agents, on haematopoiesis were well documented in the early years of HIV care; in the current era of HIV-care, the advent of newer and less toxic anti-retroviral drugs have had a more beneficial impact on haematopoiesis. Due to impaired regulation of the immune system and potential side effects of one or more anti-retroviral agents, there is also an increase in coagulation abnormalities such as thromboembolism, and less frequently, acquired disorders of coagulation including thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura and acquired inhibitors of coagulation. In this article we review the epidemiology and aetiology of select non-oncological haematological disorders commonly seen in people living with HIV-acquired immune deficiency syndrome.

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Section: Epidemiology Diagnosis and Treatment Of Haematological Abnomentioning

confidence: 99%

Haematological manifestations of human immune deficiency virus infection

Vishnu

Aboulafia

2015

Br J Haematol

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“…In the reported cases of hemophilia A in HIV infected patients, the most frequent manifestations have been soft tissue bleeding, ecchymosis, and hematuria [10-14]. Cases of hemarthrosis [10] and abnormal uterine bleeding [12] have also been described. Our patient presented a clinical picture similar to that of the reported cases with bleeding due to catheters and ecchymosis, and she also had upper gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Half of the causes of acquired hemophilia are frequently associated with conditions such as autoimmune diseases, lymphatic malignancies, medications, pregnancy, graft vs. host disease in allogeneic bone marrow transplants [8], and some infections, such as hepatitis B (HBV) and C (HCV) [9]; the other half are idiopathic. The association with human immunodeficiency virus (HIV) is rare, with four cases of acquired hemophilia A in HIV patients [10-12] and three cases in patients with HIV/HCV co-infection [9,13-14] reported in the literature. It is usually more common in the elderly and has a significant risk of mortality (15%-48%).…”

Section: Introductionmentioning

confidence: 99%

First Case of Acquired Hemophilia B in a Patient with HIV Infection: Case Report and Literature Review

Páramo

Olivera²,

Noreña³

et al. 2019

Cureus

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Acquired hemophilia B is a rare bleeding disorder in which circulating specific antibodies inhibit the coagulation factors. Usually, it is associated with autoimmune diseases, malignancy and some infections such as hepatitis B (HBV) and C (HCV) viruses. The association with the human immunodeficiency virus (HIV) is rare. We present the first case of hemophilia B acquired in a patient with HIV. A 36-year-old woman with a history of HIV infection stage 3 acquired immunodeficiency syndrome (AIDS) (CDC 2014) and glomerulopathy secondary to HIV. She consulted for subacute non-dysenteric diarrhea. During her hospitalization, bacteremia by methicillin-sensitive Staphylococcus aureus ( S.au reus) was documented, requiring hemodialysis catheter replacement with profuse bleeding during the procedure. The coagulation tests showed prolonged activated partial thromboplastin time (aPTT), normal prothrombin time (PT), mixing test with Rosner index: 8.8%, negative lupus anticoagulant, and specific tests for normal factor VIII and XI. The activity of factor IX was <50% and the inhibitor was increased, which confirms the diagnosis of hemophilia B. Acquired hemophilia B in a patient with HIV infection is not a frequent association; it should be suspected in the context of bleeding with prolonged aPTT.

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“…22 Only a small number of case reports have described an association between the presence of FVIII inhibitors and HIV infection. 17 Some occurred in patients with a history of congenital hemophilia A who after factor replacement therapy acquired alloantibodies to FVII. 22 A handful of patients coinfected with HIV and with HCV have been diagnosed with AHA.…”

Section: Discussionmentioning

confidence: 99%

“…7,[10][11][12][13][14] The association between AHA and HIV infection is largely anecdotal, with only a handful of case reports describing patients with HIV infection and FVIII inhibitors either in the backdrop of hepatitis C virus (HCV) co-infection, preexisting hemophilia, or in the context of highly active antiretroviral treatment (HAART) and immune reconstitution inflammatory syndrome (IRIS). [15][16][17][18][19] We describe the case of a man with a history of AIDS complicated by progressive multifocal leukoencephalopathy (PML), who presented with new onset bleeding and an abnormal laboratory coagulation profile. We briefly review the literature of other cases of HIV-associated AHA and discuss the care of our patient while acknowledging concerns that the immunosuppression needed to eradicate the FVIII inhibitor could also exacerbate his underlying neurological condition.…”

Section: Introductionmentioning

confidence: 99%

Cyclophosphamide Treatment for Acquired Factor VIII Inhibitor in a Patient with AIDS-Associated Progressive Multifocal Leukoencephalopathy

Malhotra

Aboulafia

2015

J Int Assoc Provid AIDS Care

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Acquired hemophilia A (AHA) is a severe bleeding disorder with high mortality rates resulting from the development of autoantibodies to factor VIII (FVIII). Patients typically present with hemorrhages in the skin, subcutaneous tissues, and muscles, which are frequently severe. They can also develop life-threatening retroperitoneal hematomas and compartment syndromes. We describe the case of a man with a long history of AIDS complicated by progressive multifocal leukoencephalopathy (PML), who developed AHA while on stable antiretroviral therapy and then presented with new onset bleeding and hypotension. We treated our patient with incrementally increasing doses of cyclophosphamide resulting in resolution of coagulopathy. We review the medical literature for additional cases of HIV-associated AHA and discuss the challenges in the care of our patient, since the immunosuppression needed to eradicate the FVIII inhibitor had the potential to cause recrudescence of his PML.

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Acquired haemophilia A associated with HIV infection

Cited by 8 publications

References 7 publications

Haematological manifestations of human immune deficiency virus infection

Haematological manifestations of human immune deficiency virus infection

First Case of Acquired Hemophilia B in a Patient with HIV Infection: Case Report and Literature Review

Cyclophosphamide Treatment for Acquired Factor VIII Inhibitor in a Patient with AIDS-Associated Progressive Multifocal Leukoencephalopathy

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