An Unexpected Journey: Thrombotic Thrombocytopenic Purpura Unveiling Hidden HIV Infection

According to World Health Organization data from July 2023, human immunodeficiency virus (HIV) remains a global public health issue, having claimed approximately 40 million lives so far, with ongoing transmissions in every country globally. Changes in hematologic parameters, such as anemia or thrombocytopenia, are among the most common complications in people living with HIV/AIDS (PLWHA). These complications arise due to the bone marrow being targeted by the combined effects of HIV infection, inflammatory mediators released in response to the infection, and opportunistic pathogens. HIV-associated thrombotic thrombocytopenic purpura (TTP) is a rare condition that can lead to end-organ ischemia and requires prompt treatment to prevent permanent organ damage. We present the case of a previously healthy 54-year-old man who presented at the emergency department with profound asthenia and unexplained weight loss of 10 kg over a few weeks. Diagnostic investigations were remarkable for a positive HIV rapid antigen/antibody combination test, severe thrombocytopenia and hemolytic anemia. As HIV-associated TTP was the likely diagnosis, the patient was transferred to the Division of Nephrology for therapeutic plasma exchange (TPE). Monitoring platelet counts and hemoglobin levels in HIV/AIDS patients affected by HIV-associated TTP is essential for assessing disease progression and identifying thrombocytopenia or its related clinical symptoms.