Vol.67 No.5 September 2019

HIV infection and hematological abnormalities

Teruhisa Fujii^{1, 2)}

¹⁾Division of Blood Transfusion, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, Japan
²⁾Aids Care Unit, Hiroshima University Hospital

Abstract

Persons with HIV (PWHs) sometimes have cytopenias, such as anemia or thrombocytopenia. These complications are often encountered, even in asymptomatic persons. The pathology underlying hematological abnormalities can be roughly classified into hematopoietic injury, acceleration of destruction, and dysplasia, all of which can be associated directly or indirectly with HIV infection. HIV can infect hematopoietic stem cells (HPSCs) expressing CD4 and or CCR5, because both are receptors for virus infection. HIV-infected HPSCs cannot only differentiate, but also proliferate, and then it results resulting in hematopoietic injury. In addition, failure of hematopoietic differentiation may occur because of the host immune response to HIV infection, including release of inflammatory cytokines. Nucleoside reverse transcriptase inhibitors such as zidovudine can cause anemia as one of their side effects. Thrombocytopenia is most commonly a result of accelerated destruction. Although HIV does not directly affect megakaryocytes and platelets as these cells do not express CD4 on their surface, it is assumed that the pathology underlying acceleration of platelet destruction is the same as that in immune thrombocytopenia (ITP). In many cases, the thrombocytopenia recovers with anti-HIV medication, but the same treatment as that for ITP is recommended for refractory cases. There are some reports indicating that PWHs often are at a high risk of developing complications such as myelodysplastic syndrome or leukemia. The characteristics of MDS in patients with HIV, as compared with those in non-HIV infected persons, are that the patients affected are younger, show a higher risk of progression to leukemia, show a poor prognosis, etc.

Key word

HIV, anemia, nucleoside reverse transcriptase inhibitor, thrombocytopenia, CD4

Received

October 9, 2018

Accepted

March 22, 2019

Jpn. J. Chemother. 67 (5): 577-582, 2019