Second International Congress Drug Therapy in HIV Infection 18-22 November 1994 Glasgow, UK

THE PATHOGENESIS AND TREATMENT OF HIV-RELATED THROMBOCYTOPENIA

Eric Oksenhendler
Hôpital Saint-Louis 1 ave C. Yellefaux 75010 Paris France

Int Cong Drug Therapy HIV 1994 Nov 18-22;2:Abstract No. 9.3
AIDS 1994, Vol. 8 (Suppl. 4);S8

Although thrombocytopenia is a frequent complication of HIV infection, the involved mechanisms are not yet fully characterized. At an early stage of HIV infection, in the absence of severe immune deficiency, the condition is very close to that observed in "classic" immune thrombocytopenic purpura (ITP): rapid, peripheral, usually splenic, platelet destruction associated with the presence of anti-platelet antibodies. The exact nature and role of platelet-associated IgG remains under discussion as immune complexes either non-specific or containing anti-F(ab')₂ IgG or HIV-specific antiidiotypic activity as well as anti-platelet gpllb/llla IgG or antibodies cross reacting with platelet antigens and HIV gp160/120 or p24 have been detected in these patients. Later in the course of HIV disease, thrombocytopenia is usually associated with a decrease of platelet production and turnover. Infection of the megakaryocytes by HIV has been demonstrated but an indirect role of the virus through dysregulation of the local production of haematopoietic growth factors is an other possible mechanism for bone marrow failure.

Zidovudine is an effective therapy providing an initial good response in 71/102 pts from our cohort study and a sustained response in 53. High dosage (≥1g/d) appears more effective. in some patients the response was maintained despite the emergence of AZT genotypicaly resistant strains and indeed there is no evidence that AZT effectiveness on ITP is mediated through its antiviral activity, Splenectomy, performed in 68 patients, was safe and effective, with a persistent response rate of 82%. Using a time-dependent Cox model and after adjustment on the baseline CD4 cell count no differences on AIDS progression rate and survival were observed between the 68 splenectomized and the 117 non-splenectomized patients from our cohort study with a mean follow-up of 6 years.

Presenting author: Eric Oksenhendler

1994-11-18
9.3

Originally published in AIDS Volume 8, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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