Impact of the highly active antiretroviral therapy era on the epidemiology of primary HIV-associated thrombocytopenia

Abstract

BackgroundPrimary HIV-associated thrombocytopenia (PHAT) typically improves with highly active antiretroviral therapy (HAART); however, cases continue to occur. Data comparing the epidemiology of PHAT between the pre-HAART and HAART eras are limited. We retrospectively examined the incidence of PHAT over 28 years in the US Military HIV Natural History Study (NHS) from 1986 to 2013.ResultsSubjects had a nadir platelet count <100 × 109/l with no other identifiable cause. Time periods were categorized as pre-HAART (1986–1995), early HAART (1996–2001), and later HAART (2002–2013). Incidence, demographic data, and CD4 count were compared across the three eras. A generalized estimating equations model was used to assess any association of platelet count and HIV viral load in cases diagnosed during the HAART eras. 218 participants met the case definition. 86.2 % of cases occurred prior to 2002. The incidence of PHAT per 1000 person-years of follow-up was 16.3, 4.6, and 1.9 during pre-HAART, early HAART and later HAART eras respectively. CD4 cell counts were significantly higher in the HAART eras at the time of thrombocytopenia (p < 0.001). Of patients diagnosed after 1996, 96.4 % were viremic within six months preceding the platelet nadir and over half were antiretroviral naïve. Viral load (per log10 copies/ml) inversely correlated with platelet count throughout the HAART eras (p < 0.0001).ConclusionsThe incidence of PHAT has markedly decreased in the HAART era. However, viremic individuals, including those with healthy CD4 cell counts, may be at risk. Achieving viral suppression as early as possible may decrease the incidence further.

Thrombocytopenia according to Antiretroviral Drug Combinations, Viremia and CD4 Lymphocytes among HIV-Infected Patients in Cameroon A Snapshot from the City of Yaoundé

“…Using the target population of PLHIV in the city of Yaounde, women appeared predominant (60.96%), similar to the natural vulnerability to HIV and the epidemiological burden in the general population In this target population of chronically infected Cameroonians, 19.03% of subjects had thrombocytopenia, almost all being mild disorders. Of note, the absence of severe thrombocytopenia can be explained by the fact that most of the patients were monitored within their routine care as outpatient, without emergency and most (79.0%) of them were on treatment against HIV infection, as appropriate ART also contribute in limiting event of thrombocytopenia [14]. The rate of thrombocytopenia slightly differs to reports from Tene et al (13.67% in 2014 within the same city) [9].…”

“…in the United States [14]. As also reported by Mbanya et al, in 2002, HIV infection can cause thrombocytopenia by various mechanisms including bone marrow destruction induced by viral activity, ART or immunological factors [15].…”

“…Among ART-naïve individuals, the burden of thrombocytopenia (37%) was slightly lower (27%) than data reported at the Yaoundé teaching Hospital (in the same township). O'Bryan et al, in the United States also showed a decreased rate of thrombocytopenia in an HIV infected population moving from the pre-therapeutic to per-ART phase [14]. Of great clinical relevance, after adjusting for age, sex, ART, viral load and CD4, only ART exposure was significantly associated with decreased risk of thrombocytopenia.…”

Thrombocytopenia according to Antiretroviral Drug Combinations, Viremia and CD4 Lymphocytes among HIV-Infected Patients in Cameroon A Snapshot from the City of Yaoundé

“…Depending on the severity of thrombocytopenia, the most predominant form was mild thrombocytopenia. The absence of severe thrombocytopenia can be explained by the fact that most of the patients followed up in Yaoundé who came for biological monitoring at the CIRCB were not in absolute emergency, and because most (79.0%) of these patients were on treatment .Furthermore it has been shown that an appropriate antiretroviral therapy is the most important step to fight thrombocytopenia [10].…”

Screening Outcomes of Hepatitis B and E among HIV Patients on HAART in Osogbo, South Western Nigeria

“…Since the advent of highly active antiretroviral therapy (HAART) introduced in 1996 [1], there has been an increase in the quality and length of life of patients placed on these drugs. The disease condition acquired Immune deficiency Syndrome (AIDS) has gradually evolved into a chronic condition however with subsequent side effects of the drugs and side effects of AIDs itself emerging as the patients live longer.…”