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HIV associated thrombotic microangiopathy
S Ahmed1, R K Siddiqui, A K Siddiqui
1Division of Hematology and Oncology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
Abstract:
Thrombotic microangiopathy (TMA) is a known complication of HIV infection. Endothelial cell injury appears to be the primary event causing platelet activation and deposition in the microvasculature. Direct cytopathic roles of HIV as well as other factors such as malignancy, drugs, and infectious agents have been implicated in the pathogenesis of HIV-TMA. Although the the majority of patients present in a more advanced stage of HIV disease, TMA can be the initial presenting symptom of HIV infection. Clinical features are those of idiopathic TMA, and the diagnosis should be suspected in any patient with new onset thrombocytopenia and microangiopathic haemolytic anaemia. Therapy with plasma exchange or infusion appears to be efficacious. A rapid diagnosis and institution of plasmapheresis is crucial for a favourable outcome. The long term prognosis of HIV-TMA is unfavourable and may depend on the stage of HIV infection. The recent data after the use of highly active retroviral treatment, however, are unavailable and current prognosis is therefore uncertain.
Insights
Thrombotic microangiopathy (TMA) is a serious complication of HIV infection, often presenting with low platelets and anemia. Prompt diagnosis and plasma exchange are vital for managing this condition.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Thrombotic microangiopathy (TMA) is a recognized complication in individuals with Human Immunodeficiency Virus (HIV) infection.
- Endothelial cell injury is the primary mechanism, leading to platelet activation and microvascular deposition.
- The pathogenesis involves direct HIV cytopathic effects, malignancy, drugs, and infections.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and management of HIV-associated TMA.
- To discuss the diagnostic criteria and therapeutic options for HIV-TMA.
- To evaluate the prognosis of HIV-TMA, considering the impact of HIV disease stage.
Main Methods:
- Literature review of HIV-TMA cases.
- Analysis of clinical features and diagnostic markers.
- Evaluation of treatment efficacy, particularly plasma exchange/infusion and plasmapheresis.
Main Results:
- TMA can be the initial presentation of HIV infection, not exclusively occurring in advanced stages.
- Clinical presentation mimics idiopathic TMA, requiring suspicion in patients with new thrombocytopenia and microangiopathic hemolytic anemia.
- Plasma exchange or infusion shows efficacy, with rapid diagnosis and plasmapheresis being crucial for favorable outcomes.
Conclusions:
- HIV-TMA necessitates prompt diagnosis and intervention with plasmapheresis for better outcomes.
- The long-term prognosis remains unfavorable and is linked to the stage of HIV infection.
- Current data on prognosis following highly active antiretroviral treatment (HAART) is limited, rendering the contemporary outlook uncertain.