Immunologic thrombocytopenic purpura in patients at risk for AIDS

HIV-seropositive homosexuals, narcotic addicts and hemophiliacs develop a new syndrome of immunologic thrombocytopenic purpura (ITP) which is clinically indistinguishable from classic autoimmune thrombocytopenic purpura (ATP) with respect to increased megakaryocytes in the bone marrow, peripheral destruction of antibody-coated platelets, negative serology for SLE, response to treatment with prednisone and/or splenectomy. Eleven of 79 homosexual patients have developed AIDS 2 to 43 months after the diagnosis of ITP (mean, 22 months). The mechanism of the ITP appears to be different in homosexuals and narcotic addicts when compared to classic ATP. Homosexuals and narcotic addicts have markedly elevated platelet-bound IgG and C3C4 (2.5-4-fold ATP levels), PEG-precipitable circulating immune complexes and anti-F(ab')2 antibodies (absent in ATP). There is no inverse relationship between platelet-bound IgG and platelet count and platelet antibody is usually not elutable from washed platelets as is the case with classic ATP. Homosexual patients do not have 7S platelet antibody in their sera as do classic ATP patients, but appear to have immune complex deposition on their platelets, possibly due to the presence of anti-F(ab')2 antibodies. Narcotic addict patients do have detectable 7S platelet antibody but also appear to have immune complex deposition on their platelets, possibly due to anti-F(ab')2 antibodies. The anti-F(ab')2 antibodies are of the IgG class. They react with autologous, homologous patient and healthy control F(ab')2 fragments. Some anti-F(ab')2 antibodies have broad reactivity, others are more limited. It is postulated that some of the anti-F(ab')2 antibodies may be responsible for the thrombocytopenia.