title: Exacerbation of microcytic anemia associated with cessation of anti-retroviral therapy in an HIV-1-infected patient with beta thalassemia.
abstract: We report a patient with Japanese minor β thalassemia and HIV-1 infection. The patient showed prolonged anemia, which was originally attributed to chronic parvovirus B19 infection. Twelve years later, the patient presented with exacerbation of microcytic anemia following cessation of anti-retroviral therapy; the exacerbation resolved when anti-retroviral therapy was resumed. Sequencing of the β globin gene revealed heterozygosity for a four-nucleotides deletion at codon 41/42 and minor β thalassemia was confirmed. Because HIV-1-infected patients frequently show anemia due to nutritional deficiencies, opportunistic infections, AIDS-related malignancies, drug treatment and a direct effect of HIV-1 on the bone marrow, it is likely to overlook other causes of anemia. Thalassemia should be considered in the differential diagnosis of anemia even in HIV-1 infected patients, when microcytic anemia without iron deficiency is observed. Our case suggested that active HIV infection may have worsened β thalassemia, and early introduction of anti-retroviral therapy is beneficial for the recovery of anemia.
authors.affiliation: Division of Blood Transfusion Medicine and Cell Therapy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. Electronic address: furukawy@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Laboratory and Vascular Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
authors.forename: Teruto
authors.initials: T
authors.lastname: Hashiguchi
authors.affiliation: Internal Medicine, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Minami
authors.affiliation: Internal Medicine, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medicine and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takashima
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017086:beta-Thalassemia / Q000821:virology*
chemical_list: D044966:Anti-Retroviral Agents
keywords: Beta thalassemia; Cessation of ART; Exacerbation of anemia; HIV infection