title: Initial Experience with the Use of Thrombopoetin Receptor Agonists in Patients with Refractory HIV-Associated Immune Thrombocytopenic Purpura: A Case Series.
abstract: HIV-associated immune thrombocytopenic purpura (ITP) has decreased in incidence 10-fold since the advent of highly active antiretroviral therapy (HAART). For patients with detectable HIV viral loads, first-line treatment approaches involve optimizing HAART followed by standard ITP options used to treat those without HIV infection. In the general population, the thrombopoetin receptor agonists (TRAs), eltrombopag and romiplostim, are effective when used as salvage ITP therapy. In addition, eltrombopag has been used effectively in patients with thrombocytopenia secondary to hepatitis C--a virus seen commonly in HIV-infected patients, especially in those who also have a history of intravenous drug use. There are, however, few reports or studies of TRAs use in those with HIV infection. Herein, we describe 5 cases of refractory HIV-associated ITP managed with TRAs. Although platelet counts improved for all patients, 2 patients succumbed to thromboembolic complications. Our initial experience, as well as our findings from a Medline review, supports the potential utility of TRA as salvage therapy in the treatment of HIV-related ITP; however, we recommend caution in the use of these agents in those who are at highest risk of thrombosis. Additional studies are needed to determine the efficacy and, more importantly, the safety of TRAs in treatment of HIV-associated ITP.
authors.affiliation: Department of Hematology/Oncology, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kowalczyk
authors.affiliation: Section of Hematology/Oncology, Stroger Hospital of Cook County, Ruth M. Rothstein CORE Center, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Rubinstein
authors.affiliation: Department of Hematology/Oncology, Virginia Mason Medical Center, Seattle, WA, USA Division of Hematology, The University of Washington School of Medicine, Seattle WA, USA hemdma@vmmc.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Aboulafia
mesh_terms: D000293:Adolescent; D000328:Adult; D001565:Benzoates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006401:Hematologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006834:Hydrazines / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000209:etiology; D011720:Pyrazoles / Q000008:administration & dosage* / Q000009:adverse effects; D011961:Receptors, Fc / Q000008:administration & dosage*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D016879:Salvage Therapy; D013926:Thrombopoietin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D001565:Benzoates; D006401:Hematologic Agents; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag
keywords: HIV/AIDS; immune thrombocytopenic purpura; thrombopoetin receptor agonists