Risk factors for thrombocytopenia in HIV-infected persons in the era of potent antiretroviral therapy.
OBJECTIVE
Before potent antiretroviral therapy, thrombocytopenia was observed frequently. Little is known about risk factors for or severity and consequences of thrombocytopenia since establishment of highly effective therapy for HIV.


METHODS
We conducted a retrospective-matched case-control study of HIV-infected adult outpatients with and without thrombocytopenia to elucidate the contribution of HIV viremia, hepatitis C infection, and other potential risk factors for thrombocytopenia. Seventy-three cases with thrombocytopenia (platelet count <100 x 10(9)/L persistent for >3 months) were matched by age, sex, and first clinic visit with 73 nonthrombocytopenic controls. Risk factors and outcomes were assessed using conditional logistic regression.


RESULTS
Nadir platelet counts in cases were <or=50 x 10(9)/L in 58% and <or=30 x 10(9)/L in 38%. In multivariate modeling, HIV RNA >400 copies/ml, hepatitis C virus infection, and cirrhosis were significantly associated with thrombocytopenia with adjusted odds ratios of 5.3 [confidence interval (CI) 1.6-17.1, P = 0.006], 6.1 (CI 1.6-22.6, P = 0.007), and 24.0 (CI 1.7-338, P = 0.019), respectively. Thrombocytopenia was significantly associated with major bleeding events and nonbleeding-related death.


CONCLUSIONS
Thrombocytopenia in the era of potent antiretroviral therapy is associated with hepatitis C virus infection, cirrhosis, and uncontrolled HIV replication, and serious complications including major bleeding and death.
Marks
Kristen M
KM
Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA. markskr@med.cornell.edu
Clarke
Robin M A
RM
Bussel
James B
JB
Talal
Andrew H
AH
Glesby
Marshall J
MJ
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006470:Hemorrhage / Q000276:immunology; D006526:Hepatitis C / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000276:immunology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000276:immunology; D014481:United States / Q000453:epidemiology
D019380:Anti-HIV Agents