title: Aetiological factors related to a positive direct antiglobulin test result in human immunodeficiency virus-infected patients.
abstract: OBJECTIVE
  The aim of this study was to examine the clinical importance and causes of a positive result in the direct antiglobulin test (DAT) in human immunodeficiency virus-infected (HIV(+)) patients. We therefore studied haematological parameters in outpatient samples, and also analysed the impact of highly active anti-retroviral therapy (HAART) on the DAT results.
  
  
  METHODS
  Haematological parameters, clinical stages, chemo-antibiotic treatments and HAART treatment were studied to determine any relationships with DAT results in 115 consecutive HIV(+) patients.
  
  
  RESULTS
  Significantly lower haemoglobin (Hb) levels were detected in patients with HIV who had a positive DAT result. Hepatitis C virus (HCV) co-infection (odds ratio 2.529) and trimethoprim-suphamethoxazfole (TMP-SMX) prophylaxis (odds ratio 3.751) had a significant association with DAT positivity. Patients receiving HAART were less likely to have a positive DAT [odds ratio (OR) 0.383; P = 0.035]. Among the patients treated with TMP-SMX, those with a positive DAT had lower Hb levels (11.9 g/dl) than those with a negative DAT (14.2 g/dl; P = 0.04). HCV antibody positivity and TMP-SMX prophylaxis showed a cumulative effect on positive DATs (OR 4.533). The surface exploratory analysis indicated the distribution of the positive DATs in relationship with the CD4(+) count and Hb levels.
  
  
  CONCLUSIONS
  Significantly lower Hb levels were detected in DAT-positive HIV(+) patients. HCV co-infection and TMP-SMX prophylaxis appear to confer an increased risk of DAT positivity. The presence of red blood cell autoantibodies may be associated with anaemia in HIV disease in the absence of overt haemolysis.
authors.affiliation: Immunohematology Laboratory, Transfusion Centre Institute of Hematology Catholic University, Roma, Italy. marco_lai@fastwebnet.it
authors.forename: M
authors.initials: M
authors.lastname: Lai
authors.forename: G
authors.initials: G
authors.lastname: d'Onofrio
authors.forename: E
authors.initials: E
authors.lastname: Visconti
authors.forename: E
authors.initials: E
authors.lastname: Tamburrini
authors.forename: R
authors.initials: R
authors.lastname: Cauda
authors.forename: G
authors.initials: G
authors.lastname: Leone
mesh_terms: D000740:Anemia / Q000097:blood / Q000209:etiology / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D003298:Coombs Test; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006454:Hemoglobins / Q000378:metabolism; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008297:Male; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D006454:Hemoglobins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination