title: Infectious causes of chronic immune thrombocytopenia.
abstract: Persistent thrombocytopenia may be the consequence of chronic infections with hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori, and should be considered in the differential diagnosis of primary immune thrombocytopenia (ITP). Studies have shown that on diagnosis of infections, treatment of the primary disease often results in substantial improvement or complete recovery of the thrombocytopenia. In patients with thrombocytopenia due to HCV-related chronic liver disease, the use of eltrombopag, a thrombopoietin receptor agonist, normalizes platelet levels, thereby permitting the initiation of antiviral therapy. Antiviral therapy with highly active antiretroviral therapy for HIV has aided in platelet recovery, with a corresponding decrease in circulating viral load. Thrombocytopenia in the absence of other disease symptoms requires screening for H. pylori, especially in countries such as Japan, where there is a high prevalence of the disease and the chances of a platelet response to eradication therapy are high.
authors.affiliation: Department of Haematology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. roberto.stasi@stgeorges.nhs.uk
authors.forename: Roberto
authors.initials: R
authors.lastname: Stasi
authors.forename: Fenella
authors.initials: F
authors.lastname: Willis
authors.forename: Muriel S
authors.initials: MS
authors.lastname: Shannon
authors.forename: Edward C
authors.initials: EC
authors.lastname: Gordon-Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents