Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome

Williamson, Bradley T.; Leitch, Heather A.

doi:10.1155/2016/8502641

Cited by 10 publications

(10 citation statements)

References 68 publications

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“…Only three of our study patients had confirmed bone marrow malignancies. In contrast, and in line with previous studies, MDS was common occurring in 27% of our patients [28,55].…”

Section: Discussionsupporting

confidence: 93%

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

et al. 2020

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Background Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology are lacking but are needed to improve outcomes. Methods HIV-infected adults with severe (haemoglobin �70g/l) or very severe anaemia (haemoglobin � 50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes and associations with anaemia severity and mortality were explored. Results 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. More than two potential causes for anaemia were present in 94% of the patients including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB infection (41.2%) and unsuppressed HIV infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 17.5 days (IQR 6-55) days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2).

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“…Only three of our study patients had confirmed bone marrow malignancies. In contrast, and in line with previous studies, MDS was common occurring in 27% of our patients [28,55].…”

Section: Discussionsupporting

confidence: 93%

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

et al. 2020

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“…Only three of our study patients had confirmed bone marrow malignancies. In contrast MDS was common occurring in 27% of our patients (27, 51).…”

Section: Discussionmentioning

confidence: 61%

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Huibers

Bates

McKew

et al. 2019

Preprint

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Background: Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology is lacking and needed to improve outcomes. Methods:HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes of severe anaemia of anaemia and associations with anaemia severity and mortality were explored.Results: 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. Over two potential causes for anaemia were present in 94% of the patients;including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB-infection (41.2%) andunsuppressed HIV-infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 16 days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2). Conclusion: Mortality among severely anaemic HIV-infected adults is strikingly high.Clinicians must be aware of the urgent need for a multifactorial approach, including starting or optimising HIV treatment; considering TB treatment, nutritional support and attention to potential renal impairment. 109HIV-infected patients with anaemia, especially in resource limiting settings, are scarce. 110Only three of our study patients had confirmed bone marrow malignancies. In contrast 111 MDS was common occurring in 27% of our patients (27, 51). 112Renal impairment was a frequent finding among our study patients and has been 113 linked to HIV disease progression, anaemia and poor outcomes in both wealthy and 114 resource limited settings (52-55). Evaluation of renal function is an important component 115 of severe anaemia treatment protocols (30, 53) since it may affect the choice of ART (52,

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“…Although allo-HCT is not practical in most HIV + patients, it is feasible and necessary in those with associated hematological malignancies. Indeed, HIV + patients are at increased risk for development of cancers, including Hodgkin and non-Hodgkin lymphomas 5 , acute leukemias 6 , myelodysplastic syndromes 7 , as well as solid tumors of the lung, bladder, and gut 5 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Evidence for persistence of the SHIV reservoir early after MHC haploidentical hematopoietic stem cell transplantation

et al. 2018

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Allogeneic transplantation (allo-HCT) has led to the cure of HIV in one individual, raising the question of whether transplantation can eradicate the HIV reservoir. To test this, we here present a model of allo-HCT in SHIV-infected, cART-suppressed nonhuman primates. We infect rhesus macaques with SHIV-1157ipd3N4, suppress them with cART, then transplant them using MHC-haploidentical allogeneic donors during continuous cART. Transplant results in ~100% myeloid donor chimerism, and up to 100% T-cell chimerism. Between 9 and 47 days post-transplant, terminal analysis shows that while cell-associated SHIV DNA levels are reduced in the blood and in lymphoid organs post-transplant, the SHIV reservoir persists in multiple organs, including the brain. Sorting of donor-vs.-recipient cells reveals that this reservoir resides in recipient cells. Moreover, tetramer analysis indicates a lack of virus-specific donor immunity post-transplant during continuous cART. These results suggest that early post-transplant, allo-HCT is insufficient for recipient reservoir eradication despite high-level donor chimerism and GVHD.

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Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome

Cited by 10 publications

References 68 publications

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Evidence for persistence of the SHIV reservoir early after MHC haploidentical hematopoietic stem cell transplantation

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