Lamivudine-induced pure red cell aplasia

Majluf‐Cruz, Abraham; Luna‐Castaños, Germán; Treviño-Pérez, Sandra; Santoscoy, Mario; Nieto‐Cisneros, Leopoldo

doi:10.1002/1096-8652(200011)65:3<189::aid-ajh2>3.0.co;2-6

Cited by 29 publications

(18 citation statements)

References 12 publications

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“…6 Previously, lamivudine has been associated with red cell aplasia. 37 However, in our present study, there was no significant adverse event associated with the use of preemptive lamivudine. Most importantly, marrow engraftment was not affected.…”

Section: Discussioncontrasting

confidence: 60%

Preemptive use of lamivudine reduces hepatitis B exacerbation after allogeneic hematopoietic cell transplantation

et al. 2002

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Exacerbation of hepatitis B virus (HBV) is a serious cause of morbidity and mortality in hepatitis B surface antigen (HBsAg)-positive patients undergoing transplantation. Our aim was to evaluate the effectiveness of lamivudine to prevent hepatitis due to exacerbation of HBV in HBsAg-positive patients treated with allogeneic hematopoietic cell transplantation. We studied 20 consecutive HBsAg-positive recipients of allogeneic hematopoietic cell transplantation who received lamivudine 100 mg daily starting one week before transplantation until week 52 after transplantation (group 1). Serial serum alanine aminotransferase and HBV DNA levels were measured before and after transplantation at 4-to 8-week intervals for the first year and then 4-to 12-week intervals. Their virologic and clinical outcomes were compared with 20 case-matched recipients who did not receive any antiviral therapy to HBV (anti-HBV) before and after hematopoietic cell transplantation (group 2). After transplantation, 9 patients (45%) in group 2 and one patient (5%) in group 1 had hepatitis due to exacerbation of HBV (P < .008), with 3 hepatic failures in group 2 and none in group 1. The one-year actuarial probability of survival without hepatitis due to exacerbation of HBV was higher in group 1 than group 2 (94.1% vs. 54.3%, P ‫؍‬ .002). By multivariate Cox analysis, preemptive use of lamivudine effectively reduced hepatitis due to exacerbation of HBV (adjusted hazards ratio, 0.09; P ‫؍‬ .021). I n an endemic area for chronic hepatitis B infection, exacerbation of this virus is a serious cause of morbidity and mortality in patients undergoing cytotoxic or immunosuppressive therapy. 1,2 Careful prospective serologic testing has shown that liver damage due to exacerbation of hepatitis B virus (HBV) is a 2-stage process. The initial stage occurs during intense cytotoxic or immunosuppressive therapy and is characterized by enhanced viral replication, as reflected by increases in serum levels of HBV DNA, hepatitis B e antigen, and HBV DNA polymerase, which presumably results in widespread infection of hepatocytes. The second stage is related to restoration of immune function following withdrawal of cytotoxic or immunosuppressive therapy, which causes rapid immune-mediated destruction of infected hepatocytes. Clinically, this may lead to hepatitis, hepatic failure, and even death. [3][4][5] In keeping with these observations, our recent data suggest that a high pretreatment level of serum HBV DNA is the single most important factor for exacerbation of HBV after intense immunosuppression. 6 In the past few decades, hematopoietic cell transplantation has been established as the standard treatment of various hematologic and oncologic problems. 7 In areas such as Southeast Asia, where HBV infection is prevalent, hematopoietic cell transplantation might be complicated by HBV-related morbidity and mortality. 8 The pre-heAbbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; anti-HBV, antibody to hepatitis B virus; PCR, polymerase chain ...

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Section: Discussioncontrasting

confidence: 60%

Preemptive use of lamivudine reduces hepatitis B exacerbation after allogeneic hematopoietic cell transplantation

et al. 2002

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“…In the present case, the patient's peripheral blood CD4 + and CD8 + T cell counts and CD4/CD8 ratio were within the normal limits. Furthermore, we detected neither T cell proliferation in the bone marrow nor an elevated blood CD4/CD8 ratio; however, other clinical cases of PRCA in HIV patients have been reported in the absence of obvious T cell activation (5,16). These facts suggest that PRCA can occur in HIV patients, who are expected to exhibit impaired T cell-mediated immunity.…”

Section: Discussioncontrasting

confidence: 69%

“…Furthermore, 3TC is known to delay viral resistance to zidovudine (ZDV) and enhance the effects of ZDV in patients previously treated with ZDV (2). However, anemia has been reported in 3TC-treated patients who have received either concomitant or previous ZDV treatment (3)(4)(5). A case of 3 TC-induced pure red cell aplasia (PRCA) was recently reported in an HIV-infected patient with an acute bacterial infection who had not been previously treated with ZDV (6).…”

Section: Introductionmentioning

confidence: 99%

Pure Red Cell Aplasia Induced by Lamivudine without the Influence of Zidovudine in a Patient Infected with Human Immunodeficiency Virus

et al. 2014

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We herein report the case of a patient with human immunodeficiency virus infection and acquired immune deficiency syndrome who was diagnosed with drug-induced pure red cell aplasia consequent to lamivudine treatment. The patient was admitted to our hospital for treatment of increasing shortness of breath following physical effort. Upon admission, routine blood tests revealed a hemoglobin level of 7.6 g/dL and a hematocrit proportion of 21.2%, with normal leukocyte and platelet counts. After stopping the lamivudine treatment, the patient's hemoglobin concentration and hematocrit level returned to normal. A bone marrow examination showed an exclusive reduction in erythrocyte formation. This case indicates that lamivudine can induce severe anemia without the influence of zidovudine.

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“…[89] Repeat bone marrow aspiration was not performed in the patient. Therefore, we believe that PRCA was secondary to Zidovudine.…”

Section: Discussionmentioning

confidence: 99%

Zidovudine-induced reversible pure red cell aplasia

et al. 2010

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Hematological abnormalities are frequent among human immunodeficiency virus (HIV)-infected patients and may be directly attributable to the virus or may be caused by opportunistic infections, neoplasms or drugs that cause bone marrow suppression or hemolysis. Pure red cell aplasia (PRCA) is an uncommon hematological disorder that causes anemia. We report a 37-year-old male with HIV infection who developed PRCA 6 weeks after commencing Zidovudine and recovered following cessation of the drug. This is the first case of Zidovudine-induced PRCA reported from the Indian subcontinent.

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Lamivudine-induced pure red cell aplasia

Cited by 29 publications

References 12 publications

Preemptive use of lamivudine reduces hepatitis B exacerbation after allogeneic hematopoietic cell transplantation

Preemptive use of lamivudine reduces hepatitis B exacerbation after allogeneic hematopoietic cell transplantation

Pure Red Cell Aplasia Induced by Lamivudine without the Influence of Zidovudine in a Patient Infected with Human Immunodeficiency Virus

Zidovudine-induced reversible pure red cell aplasia

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