Thrombocytopenia in HIV Disease: Clinical Relevance, Physiopathology and Management

Míguez‐Burbano, Maria José; Jackson, J. Brooks; Hadrigan, Sonya

doi:10.2174/156801605774322364

Cited by 37 publications

(31 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, analyses indicated even lower CD4 cell counts in patients who were heavy drinkers and exhibited thrombocytopenia (210 ± 180 cells/μl), compared to those non-drinkers with normal platelets (347 ± 181.5 cells/μl). Finally, in accord with our previous report [18–20] no significant changes in platelet counts were observed before and after HAART.…”

Section: Resultssupporting

confidence: 93%

The role of alcohol on platelets, thymus and cognitive performance among HIV-infected subjects: Are they related?

et al. 2009

View full text Add to dashboard Cite

Our objective was to evaluate whether thrombocytopenia and small thymus volume, which may be associated with hazardous alcohol consumption, are predictors of cognitive performance after highly-active antiretroviral treatment (HAART). To achieve this goal 165 people living with HIV starting HAART underwent thymus magnetic resonance imaging, cognitive (HIV Dementia Score [HDS] and the California Verbal Learning Test [CVLT]), immune and laboratory assessments at baseline and after 6 months of HAART. At baseline, hazardous alcohol consumption was significantly correlated with both thymus size (r = −0.44, p = 0.003) and thrombocytopenia (r = 0.28, p = 0.001). Of interest, thrombocytopenic patients were characterized by a smaller thymus size. Individuals with and without cognitive impairment differed in alcohol consumption, platelet counts and thymus size, suggesting that they may be risk factors for neurological abnormalities. In fact, after HAART hazardous alcohol use associations with thrombocytopenia were related to cognitive decline (learning = −0.2 ± 0.8, recall = −0.3 ± 0.1 and HDS = −0.5). This contrasted with improvements on every cognitive measure (learning = 1.6 ± 0.3, p = 0.0001, recall = 2.2 ± 0.4, p = 0.0001 and HDS = 1.0, p = 0.05) in those with neither alcohol use nor thrombocytopenia. In adjusted analyses for sociodemographics, adherence and immune measurements, reduced thymus size was associated with a 90% and thrombocytopenia with a 70% increase in the risk of scoring in the demented range after HAART (RR = 1.9, p < 0.05 and RR = 1.7, p = 0.03) and with low CLVT scores (thymus volume RR = 2.0, p = 0.04, chronic alcohol use p = 0.05 and thrombocytopenia p = 0.06). Thymus volume and platelet counts were negatively affected by alcohol and were predictors of cognitive performance and improvements after HAART. These results could have important clinical and therapeutic implications.

show abstract

Section: Resultssupporting

confidence: 93%

The role of alcohol on platelets, thymus and cognitive performance among HIV-infected subjects: Are they related?

et al. 2009

View full text Add to dashboard Cite

show abstract

“…10 Thrombocytopenia is characterised by platelet counts below 125×10 3 /mm 3 , and also frequently occurs in HIV-infected patients. [11][12][13] Haematological parameters mainly anaemia and leukopaenia in HIV-infected ART-naïve patients result in poor ART-treatment outcome and otherwise strongly predict mortality. 2 14 15 Although haematological abnormalities are common manifestations of HIV infection and AIDS, and may have considerable impact on patients' well-being, treatment and care, few studies on haematological parameters in HIV-infected persons have been undertaken in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

et al. 2012

View full text Add to dashboard Cite

ObjectivesAlthough haematological abnormalities are common manifestations of HIV infection, few studies on haematological parameters in HIV-infected persons have been undertaken in sub-Saharan Africa. The authors assessed factors associated with haematological parameters in HIV-infected antiretroviral-naïve and HIV-uninfected Rwandan women.Study designCross-sectional analysis of a longitudinal cohort.SettingCommunity-based women's associations.Participants710 HIV-infected (HIV+) antiretroviral-naïve and 226 HIV-uninfected (HIV−) women from the Rwanda Women's Interassociation Study Assessment. Haematological parameters categorised as (abnormal vs normal) were compared by HIV status and among HIV+ women by CD4 count category using proportions. Multivariate logistic regression models using forward selection were fit.ResultsPrevalence of anaemia (haemoglobin (Hb) <12.0 g/dl) was higher in the HIV+ group (20.5% vs 6.3%; p<0.001), and increased with lower CD4 counts: ≥350 (7.6%), 200–349 (16%) and <200 cells/mm3 (32.2%). Marked anaemia (Hb <10.0 g/dl) was found in 4.2% of HIV+ and none of the HIV− women (p<0.001), and was highest in HIV+ women with CD4 <200 cells/mm3 (8.4%). The HIV+ were more likely than HIV− women (4.2 vs 0.5%, respectively, p=0.002) to have moderate neutropenia with white blood cells <2.0×103 cells/mm3 and 8.4% of HIV+ women with CD4 <200 cells/mm3 had moderate neutropenia. In multivariate logistic regression analysis, BMI (OR 0.87/kg/m2, 95% CI 0.82 to 0.93; p<0.001), CD4 200–350 vs HIV− (OR 3.59, 95% CI 1.89 to 6.83; p<0.001) and CD4 <200 cells/mm3 vs HIV− (OR 8.09, 95% CI 4.37 to 14.97; <0.001) had large independent associations with anaemia. There were large independent associations of CD4 <200 cells/mm3 vs HIV− (OR 7.18, 95% CI 0.78 to 65.82; p=0.081) and co-trimoxazole and/or dapsone use (OR 5.69, 95% CI 0.63 to 51.45; p=0.122) with moderate neutropenia.ConclusionsAnaemia was more common than neutropenia or thrombocytopenia in the HIV-infected Rwandan women. Future comparisons of haematological parameters in HIV-infected patients before and after antiretroviral therapy initiation are warranted.

show abstract

“…Specifically, PTM tend to fairly rapidly progress to AIDS after SIV infection, and this progression is often associated with thrombocytopenia (TCP) (2,39). Indeed, TCP is also a common manifestation of AIDS in untreated human immunodeficiency virus (HIV)-infected individuals and is likely associated with immune activation but can be treated clinically with antiinflammatory medications (32,44). Furthermore, prior to infection with SIV, PTM often have damage to their mucosal integrity, increased microbial translocation, increased immune activation, and decreased frequencies of naïve T cells compared to RM, which may contribute to the increased rates of progression to AIDS observed after SIV infection of PTM (30).…”

mentioning

confidence: 99%

Dynamics of Simian Immunodeficiency Virus SIVmac239 Infection in Pigtail Macaques

Klatt

Canary

Vanderford

et al. 2012

J Virol

View full text Add to dashboard Cite

Pigtail macaques (PTM) are an excellent model for HIV research; however, the dynamics of simian immunodeficiency virus (SIV) SIVmac239 infection in PTM have not been fully evaluated. We studied nine PTM prior to infection, during acute and chronic SIVmac239 infections, until progression to AIDS. We found PTM manifest clinical AIDS more rapidly than rhesus macaques (RM), as AIDS-defining events occurred at an average of 42.17 weeks after infection in PTM compared to 69.56 weeks in RM (P ‫؍‬ 0.0018). However, increased SIV progression was not associated with increased viremia, as both peak and set-point plasma viremias were similar between PTM and RM (P ‫؍‬ 0.7953 and P ‫؍‬ 0.1006, respectively). Moreover, this increased disease progression was not associated with rapid CD4 ؉ T cell depletion, as CD4 ؉ T cell decline resembled other SIV/human immunodeficiency virus (HIV) models. Since immune activation is the best predictor of disease progression during HIV infection, we analyzed immune activation by turnover of T cells by BrdU decay and Ki67 expression. We found increased levels of turnover prior to SIV infection of PTM compared to that observed with RM, which may contribute to their increased disease progression rate. These data evaluate the kinetics of SIVmac239-induced disease progression and highlight PTM as a model for HIV infection and the importance of immune activation in SIV disease progression.

show abstract

Thrombocytopenia in HIV Disease: Clinical Relevance, Physiopathology and Management

Cited by 37 publications

References 107 publications

The role of alcohol on platelets, thymus and cognitive performance among HIV-infected subjects: Are they related?

The role of alcohol on platelets, thymus and cognitive performance among HIV-infected subjects: Are they related?

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

Dynamics of Simian Immunodeficiency Virus SIVmac239 Infection in Pigtail Macaques

Contact Info

Product

Resources

About