HIV associated thrombotic microangiopathy.

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.