Impaired liver function and retroviral activity are risk factors contributing to HIV-associated thrombocytopenia. Swiss HIV Cohort Study.
OBJECTIVE
To investigate the relationship between thrombopoetin (TPO) serum levels and HIV-associated thrombocytopenia.


METHODS
The relationship between TPO levels and severity of HIV-associated thrombocytopenia was investigated. Thirty-eight patients (19 patients with 30-96x10(9) platelets/l and 19 patients with <10x10(9) platelets/l) were matched with 38 HIV-positive non-thrombocytopenic patients (>150x10(9) platelets/l).


RESULTS
HIV-positive patients with normal platelet counts had a median TPO serum level of 137 pg/ml. Patients with 30-96x10(9) platelets/l had decreased TPO levels with a median of 90 pg/ml (P = 0.016), and were more likely to have elevated serum aspartate-transferase levels (P<0.001) and hepatomegaly by palpation or ultrasound imaging (P = 0.005). The median TPO serum level of HIV-infected patients with severe thrombocytopenia was 110 pg/ml (non-significant). All patients with severe thrombocytopenia were positive for antibodies against hepatitis B virus core antigen, compared with 80% of HIV-infected persons without thrombocytopenia. Patients with severe thrombocytopenia were more likely to have high HIV replication compared to patients with normal platelet counts (P = 0.02), and reduction of plasma HIV-1 RNA levels was associated with increasing platelet counts. Severe thrombocytopenia was not associated with liver disease.


CONCLUSIONS
Liver disease predisposes for low TPO serum levels and mild thrombocytopenia. High retroviral activity predisposes for severe, immune thrombocytopenic purpura-like thrombocytopenia. At least two distinct categories of severe HIV-associated thrombocytopenia exist, one responsive to antiretroviral treatment and one non-responsive to antiretroviral treatment.
Ciernik
I F
IF
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zürich, Switzerland.
Cone
R W
RW
Fehr
J
J
Weber
R
R
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015497:HIV-1 / Q000235:genetics; D006470:Hemorrhage; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D010976:Platelet Count; D012307:Risk Factors; D013163:Splenomegaly / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology*; D013926:Thrombopoietin / Q000097:blood*; D019562:Viral Load
D013926:Thrombopoietin