THROMBOTIC MICROANGIOPATHY AND CYTOMEGALOVIRUS DISEASE IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Thrombotic microangiopathy (TMA) fan occur during the course of human immunodeficiency virus (HIV) infection. Clinical and pathological data for 29 patients with TM and HIV infection were recorded. In a retrosp ective case-control study, we analyzed the link between opportunistic infections or drug therapies and TMA. Twenty-five patients (mean CD4() cell count +/- SD, 71.9 +/- 18.3/mm(3)) had renal impairment, and fo ur had neurological dysfunction. In one-half the cases, the disease wa s progressive with isolated fragmentation anemia appearing several mon ths before the clinical symptoms. The diagnosis of TMA was confirmed b y histological examination of kidney biopsy specimens (18 cases). Endo thelial cytomegalovirus (CMV) inclusions were associated with TMA in n ine of 18 eases, whereas histological examination did not detect CMV i n any control specimens (P < .001). The case-control study demonstrate d a link between TMA and clinical CMV infection (odds ratio, 3.9; 95% confidence interval, 1.1-14). We conclude that TMA is a late complicat ion of HIV infection and can be associated with systemic CMV infection in this setting.