Risk for HIV-Related Thrombocytopenia Plunges in the Combination ART Era

Keith Henry, MD reviewing Franzetti M et al.

The incidence of severe HIV-related thrombocytopenia decreased by 76% over an 18-year period with the use of increasingly effective combination antiretroviral therapy.

Thrombocytopenia was a common complication of HIV infection. To determine how the incidence of severe thrombocytopenia (defined as <50,000 platelets/µL) has changed since the early days of antiretroviral therapy (ART), researchers assessed the incidence and predictors of this condition in HIV-infected patients treated at a clinic in Italy between 1985 and 2012.

The retrospective, single-center study was divided into three periods based on ART strategies: 1985–1989 (no ART/AZT monotherapy), 1990–1996 (dual nucleoside transcriptase inhibitors), and 1997–2012 (combination ART). A total of 5137 patients were included (74% male; mean age, 35; 45% with a history of intravenous drug use [IVDU]); among those with baseline test results available, 8% had hepatitis B and 44% had hepatitis C. All had platelet counts >50,000/µL on enrollment.

The overall incidence of severe thrombocytopenia per 1000 patient-years of follow-up fell from 63 to 15 cases over the three ART-strategy eras. In patients with opportunistic infections, incidence fell from 23 to 3 cases; however, for those with chronic severe liver disease (from viral hepatitis or alcohol abuse), it increased from 2 to 5 cases. In multivariate analysis, IVDU, an AIDS diagnosis, a lower baseline platelet count, higher alanine aminotransferase levels, lower CD4-cell counts, and later year of study enrollment were associated with higher risk for developing severe thrombocytopenia; use of combination ART was associated with lower risk.

Citation(s):

Franzetti M et al. Changes in the incidence of severe thrombocytopenia and its predisposing conditions in HIV-infected patients since the introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2014 Dec 15; 67:493.