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

Abstract

The prevalence and predisposing factors of thrombotic microangiopathy (TMA) in the era of highly active antiretroviral therapy (HAART) were evaluated among patients in the Collaborations in Human Immunodeficiency Virus (HIV) Outcomes Research/US cohort. Of 6022 patients, 17 (0.3%) had TMA, with unadjusted incidences per 100 person-years of 0.079 for TMA, 0.009 for thrombotic thrombocytopenic purpura, and 0.069 for hemolytic-uremic syndrome. Compared with patients without TMA, patients with TMA had lower mean CD4(+) cell counts (197 vs. 439 cells/mm(3); P=.0009) and higher mean log(10) HIV-1 RNA levels (4.6 vs. 3.3 copies/mL; P=.0001) at last follow-up and a significantly greater incidence of acquired immune deficiency syndrome (82.4% vs. 55.3%; P=.025), Mycobacterium avium complex infection (17.6% vs. 3.3%; P=.018), hepatitis C (29.4% vs. 11.3%; P=.001), and death (41.2% vs. 7.4%; P<.0001). The prevalence of herpes and use of antiherpetics were slightly higher for patients with TMA, but unadjusted distributions were not statistically significant. TMA in a cohort surveyed after the introduction of HAART was rare and was associated with advanced HIV disease.

Thrombotic Microangiopathy and the Kidney

“…TMA has been reported in association with HIV, more commonly in the pre-highly active antiretroviral therapy era (75)(76)(77), and in association with lower CD4 1 cell counts and higher viral RNA levels (77). The pathogenic mechanisms are poorly understood, although endothelial damage is thought to be the primary event.…”

Thrombotic thrombocytopenic purpura: recognition and management

“…Fortunately, the era of highly advanced anti-retroviral therapy (HAART) has brought about a decline in incidence of HIV-TMA to well-under 1% of HIV-infected patients [18]. A high response rate is reported to plasma infusion and anti-retroviral therapy, reducing the need for plasma exchange in treating this complication [19,20].…”

Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A crosssectional study

“…58 TTP is usually characterised by microvascular platelet deposition and thrombus formation in selected organs with eventually thrombocytopenia, fever and haemolytic anaemia, neurological and renal dysfunction, among others. 59 In HIV patients, the causes of leucopenia include (1) reduced bone marrow activity from infiltrative conditions, marrow toxicity, and nutritional deficiency; (2) increased apoptosis; (3) HIV infection itself; (4) tuberculous marrow infiltrate; and (5) neoplastic infiltrates. [60][61][62] On the other hand, most drugs which are currently useful in HIV, such as CTX, AZT, and gancyclovir are myelotoxic, 63 and they can potentially cause neutropenia.…”