Parvovirus B19-associated pure red cell aplasia in the setting of HIV and competing health risks

An HIV positive, early adolescent girl from rural Southern Africa required multiple hospital admissions for severe normocytic anaemia. As she was virologically suppressed on antiretrovirals, the initial anaemia workup focused on nutritional deficiencies and excluding chronic haemolysis. A lack of readily available expertise and resources contributed to a delay in investigations, during which she was treated symptomatically with blood transfusions. She was later transferred to a tertiary hospital where she was diagnosed with parvovirus B19 (B19V) associated pure red cell aplasia. Intravenous immunoglobulin was administered with a good clinical response. The delayed diagnosis and treatment had a significant impact on her and her family and placed further strain on limited available transfusion resources. This case emphasises that B19V infection should not be overlooked as a cause of anaemia in people living with HIV, irrespective of virological and immunological HIV control. Environmental and age-group-specific risk factors should be considered.