THROMBOTIC MICROANGIOPATHY AND RETROVIRAL INFECTIONS - A 13-YEAR EXPERIENCE

Eleven of fifty serum samples collected from patients with a diagnosis of thrombotic microangiopathy (TMA), from 1979 to 1991, tested positi ve for antiretroviral antibodies. Seven had human immunodeficiency vir us (HIV) infection, and four had human lymphotrophic virus, type I (HT LV-I) infection. All patients were treated with plasma exchange and/or infusion, but only two of the HIV-infected patients obtained a comple te response (CR) and one of them died after a few months. Combined res ults from the literature indicate that most patients with HIV infectio n survive less than one year from the initial diagnosis of TMA. In the setting of HIV infection, TMA is a treatable condition, but survival for most patients is less than 12 months. Three of the four HTLV-I inf ected patients with TMA had a CR. These observations strongly suggest that both HIV and HTLV-I infections are associated with TMA, but rigor ous epidemiologic studies will be needed to determine the relative ris k for each. Retroviral infections should be considered in patients wit h TMA, especially if the patient has associated risk factors and demog raphic characteristics.(C) 1994 Wiley-Liss, Inc.