Immune thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection

Abstract

Little research focuses on the association between immune thrombocytopenic purpura and human immunodeficiency virus infection in Taiwan. This study investigated whether immune thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection in Taiwan. We conducted a retrospective population-based cohort study using data of individuals enrolled in Taiwan National Health Insurance Program. There were 5472 subjects aged 1-84 years with a new diagnosis of immune thrombocytopenic purpura as the purpura group since 1998-2010 and 21,887 sex-matched and age-matched, randomly selected subjects without immune thrombocytopenic purpura as the non-purpura group. The incidence of human immunodeficiency virus infection at the end of 2011 was measured in both groups. We used the multivariable Cox proportional hazards regression model to measure the hazard ratio and 95 % confidence interval (CI) for the association between immune thrombocytopenic purpura and human immunodeficiency virus infection. The overall incidence of human immunodeficiency virus infection was 6.47-fold higher in the purpura group than that in the non-purpura group (3.78 vs. 0.58 per 10,000 person-years, 95 % CI 5.83-7.18). After controlling for potential confounding factors, the adjusted HR of human immunodeficiency virus infection was 6.3 (95 % CI 2.58-15.4) for the purpura group, as compared with the non-purpura group. We conclude that individuals with immune thrombocytopenic purpura are 6.47-fold more likely to have human immunodeficiency virus infection than those without immune thrombocytopenic purpura. We suggest not all patients, but only those who have risk factors for human immunodeficiency virus infection should receive testing for undiagnosed human immunodeficiency virus infection when they develop immune thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura relapse induced by acute hepatitis E transmitted by cryosupernatant plasma and successfully controlled with ribavirin

“…TTP is a thrombotic microangiopathy that results from severe ADAMTS‐13 deficiency. It is well recognized that TTP exacerbations can be triggered by acute infections . In fact, our patient's previous TTP episode occurred after a respiratory infection due to influenza A virus.…”

“…It is well recognized that TTP exacerbations can be triggered by acute infections. 16,17 In fact, our patient's previous TTP episode occurred after a respiratory infection due to influenza A virus. At that episode, oseltamivir therapy did not suffice to control TTP, and plasmapheresis was also needed, which resulted in the transfusion-transmitted acute hepatitis E. Some cases of TTP triggered by an infectious agent have been controlled after resolution of the infection spontaneously or following antiviral/antibiotic treatment, although fatal outcomes have also been reported.…”

Weight loss might be an early clinical feature of undiagnosed human immunodeficiency virus infection in Taiwan

“…Comorbidities in the study were included as follows: cancer (ICD-9 codes 140-208), diabetes mellitus (ICD-9 code 250), drug dependence (ICD-9 code 304), thyrotoxicosis (ICD-9 code 242), and venereal diseases (ICD-9 codes 090-099), which were all adapted from previous studies [ 9 , 10 , 24 – 38 ].…”

Immune thrombocytopenic purpura and infections

“…The interesting paper by Lai et al reports that immune thrombocytopenic purpura (ITP) can be due to cross-reacting antibodies between human immunodeficiency virus (HIV) and platelet glycoproteins [1]. The pathogenic mechanism of ITP consists of phagocytosis of platelets by cells of the reticuloendothelial system; these cells recognize and capture platelets owing to the presence on their surface of autoantibodies (autoAb).…”

“…The pathogenic mechanism of ITP consists of phagocytosis of platelets by cells of the reticuloendothelial system; these cells recognize and capture platelets owing to the presence on their surface of autoantibodies (autoAb). These autoAb can be elicited by several infections, such as those caused by HIV and hepatitis C virus (HCV), through mechanisms of antigenic mimicry, as clearly indicated by Lai et al [1]. The ability to recognize HIV and HCV infections is certainly of high impact as both diseases can be deadly if not cured, but they are now treatable with antivirals.…”