Pure red cell aplasia and HIV infection: what to suspect?

Vaz, Sara; Guerra, Isabel Couto; Freitas, Maria Inês; Marquès, Laura

doi:10.1136/bcr-2018-224625

Cited by 5 publications

(5 citation statements)

References 3 publications

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“…[ 8 ] However, several case reports have indicated that relapse can occur when IVIG treatment is interrupted. [ 2 ] Vaz et al [ 9 ] reported that B19V-mediated PRCA could be successfully treated with ART alone, without the need for IVIG. Consistent with these observations, two of our patients (cases 2 and 3) remained in remission for more than 6 months after treatment with red blood cell transfusion and ART, without IVIG.…”

Section: Discussionmentioning

confidence: 99%

Pure Red Cell Aplasia Caused by Parvovirus B19 in Patients with Human Immunodeficiency Virus Infection: A Series of Four Cases

Wang

Fan

et al. 2023

Infect Dis Immun

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Parvovirus B19 (B19V) infection can cause pure red cell aplasia (PRCA) in patients with human immunodeficiency virus (HIV) infection. Intravenous immunoglobulin (IVIG) is a preferred treatment option. From July 2019 to March 2022, four patients with HIV infection were admitted to Guangzhou Eighth People's Hospital with dizziness and fatigue and were diagnosed with PRCA. Blood investigations revealed severe anemia and the B19V genome. Therefore, the four patients were diagnosed with B19V-induced PRCA. All four patients received red blood cell transfusion in the setting of antiretroviral therapy, and two of the four patients received intravenous immunoglobulin (IVIG). After 3-7 months of treatment, all four patients recovered, although two did not receive IVIG. This suggests that IVIG is not always necessary for the treatment of PRCA in patients with HIV infection and that effective antiretroviral therapy and immunological reconstitution play an important role in the eradication of parvovirus.

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Section: Discussionmentioning

confidence: 99%

Pure Red Cell Aplasia Caused by Parvovirus B19 in Patients with Human Immunodeficiency Virus Infection: A Series of Four Cases

Wang

Fan

et al. 2023

Infect Dis Immun

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“…It is likely that these observed, early relapses in the aforementioned studies [ 9 , 16 ] arose due to inadequate CD4 T-lymphocyte recovery, either due to older, less efficacious anti-retroviral HIV therapies, non-compliance with prescribed treatments, or reduced doses of initial IVIG therapy. Other case reports have shown that parvovirus-B19-mediated PRCA can be successfully treated in the short term with HAART alone, without the need for IVIG [ 17 , 18 ]. However, the relapse rate among such patients is unknown due to the paucity of long-term follow-up data.…”

Section: Discussionmentioning

confidence: 99%

“…Effective therapies include drug combinations from at least two different drug classes and >95% lifelong adherence to therapy [ 19 , 20 ]. In PRCA caused by chronic parvovirus-B19 viraemia in HIV patients, the rapid institution of HAART therapy rekindles the immune response to sequester parvovirus-B19 particles and facilitates erythroid recovery in the marrow [ 17 , 18 ]. Intravenous immunoglobulin (IVIG) and transfusion support are also regarded as adjunctive therapeutic strategies used in combination with HAART to manage severe and persistent parvovirus-B19-mediated PRCA [ 14 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated Anemia in a 69-Year-Old Man with HIV-1: Features of Pure Red Cell Aplasia Mediated by Chronic Parvovirus-B19 Infection

Wylde¹,

Berneri²,

Malherbe³

et al. 2022

Am J Case Rep

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Patient: Male, 64-year-old Final Diagnosis: Parvovirus-B19 pure red cell aplasia Symptoms: Lethargy • syncope • weight loss Medication: — Clinical Procedure: Blood transfusion • bone marrow biopsy • immunoglobulin therapy Specialty: Hematology • Infectious Diseases • General and Internal Medicine Objective: Rare disease Background: Pure red cell aplasia (PRCA) is an uncommon syndrome characterized by ineffective erythropoiesis and severe anemia. Among immunodeficient patients, including those with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), persistent parvovirus-B19 can cause PRCA. We report a rare case of an Australian man with parvovirus-B19 mediated PRCA secondary to a new diagnosis of HIV-1/AIDS. The case highlights the importance of early treatment initiation with anti-retroviral drugs and pooled immunoglobulins to enable marrow recovery and long-term disease remission. Case Report: A 64-year-old man residing in rural Indonesia presented with severe anemia. Apart from 8 kg of unintentional weight loss, he denied any occult bleeding, diatheses, or constitutional symptoms. His bloodwork revealed a normocytic, normochromic anemia (Hb 81 g/L) with profound reticulocytopenia (9.5×10 9 /L). Parvovirus-B19 serology and polymerase chain reaction testing confirmed active viremia. Lymphopenia and an undetectable CD4 T-lymphocyte count (<1%) were also noted; HIV-1 was subsequently diagnosed. Bone marrow sampling later confirmed features consistent with parvovirus-B19-driven PRCA secondary to HIV-1/AIDS. The patient received 1 g/kg intravenous immunoglobulin for two days and initiated anti-retroviral HIV therapy. Rapid reticulocytosis with slow incrementation of his hemoglobin were observed over one month. At three years following his diagnosis, he remains in remission. Conclusions: Severe, isolated anemia in immunodeficient patients, particularly those with HIV-1/AIDS, should prompt consideration of parvovirus-B19-mediated PRCA. Depletion of CD4-T-lymphocyte populations enables the establishment of parvovirus-B19 reservoirs within erythroid progenitors, thereby hampering physiological erythropoiesis. Long-term remission can be achieved with the rapid institution of intravenous immunoglobulin and anti-retroviral HIV therapies.

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“…Pure red cell aplasia (PRCA) has been described in patients living with HIV/AIDS (PLWHA), affecting up to 4.5% of patients [ 2 , 3 ]. Therefore, some authors recommend the prompt consideration of B19V-mediated PRCA for PLWHA with severe isolated anemia [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentation of Parvovirus B19 Infection in Adults Living with HIV/AIDS: A Case Series

Mendes-de-Almeida

Bokel

Alves

et al. 2023

Viruses

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Parvovirus B19 (B19V) infection varies clinically depending on the host’s immune status. Due to red blood cell precursors tropism, B19V can cause chronic anemia and transient aplastic crisis in patients with immunosuppression or chronic hemolysis. We report three rare cases of Brazilian adults living with human immunodeficiency virus (HIV) with B19V infection. All cases presented severe anemia and required red blood cell transfusions. The first patient had low CD4+ counts and was treated with intravenous immunoglobulin (IVIG). As he remained poorly adherent to antiretroviral therapy (ART), B19V detection persisted. The second patient had sudden pancytopenia despite being on ART with an undetectable HIV viral load. He had historically low CD4+ counts, fully responded to IVIG, and had undiagnosed hereditary spherocytosis. The third individual was recently diagnosed with HIV and tuberculosis (TB). One month after ART initiation, he was hospitalized with anemia aggravation and cholestatic hepatitis. An analysis of his serum revealed B19V DNA and anti-B19V IgG, corroborating bone marrow findings and a persistent B19V infection. The symptoms resolved and B19V became undetectable. In all cases, real time PCR was essential for diagnosing B19V. Our findings showed that adherence to ART was crucial to B19V clearance in HIV-patients and highlighted the importance of the early recognition of B19V disease in unexplained cytopenias.

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Pure red cell aplasia and HIV infection: what to suspect?

Cited by 5 publications

References 3 publications

Pure Red Cell Aplasia Caused by Parvovirus B19 in Patients with Human Immunodeficiency Virus Infection: A Series of Four Cases

Pure Red Cell Aplasia Caused by Parvovirus B19 in Patients with Human Immunodeficiency Virus Infection: A Series of Four Cases

Isolated Anemia in a 69-Year-Old Man with HIV-1: Features of Pure Red Cell Aplasia Mediated by Chronic Parvovirus-B19 Infection

Clinical Presentation of Parvovirus B19 Infection in Adults Living with HIV/AIDS: A Case Series

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