S. Carbonara et al., Response of severe HIV-associated thrombocytopenia to highly active antiretroviral therapy including protease inhibitors, J INFECTION, 42(4), 2001, pp. 251-256
Objective: To investigate the response of HIV-associated severe thrombocyto
penia (STP) to highly active antiretroviral therapy (HAART) including prote
ase-inhibitors.
Methods: In this retrospective study, IS patients with HIV-associated STP (
platelet count < 50 x 10(9)/l), mostly antiretroviral experienced (13/15),
underwent HAART for at least 6 months (median 21; range 6-41 months) during
which the platelet (PIT) count and plasmatic HIV-RNA were monitored. The P
LT response was compared to that observed in 19 patients previously treated
with zidovudine (AZT) monotherapy.
Results: HAART induced a significant increase in the PLT count (chi (2) = 1
0.53, P = 0.01) within the third month which was sustained up to the sixth
month of therapy. No STP relapse was observed among eight PLT responders fo
llowed for longer than 6 months (median 27; range 7-41 months). The PLT inc
rease after HAART was similar to that observed with AZT monotherapy, but a
greater number of HAART patients were antiretroviral-experienced. HAART det
ermined a PIT response in 10/13 subjects whose thrombocytopenia had not imp
roved after previous AZT monotherapy. After 6 months of HAART, a complete p
latelet response occurred more frequently in patients with undetectable pla
sma HIV-RNA levels (P = 0.01).
Conclusions: HAART induces a sustained PLT response in HIV-associated STP,
even in antiretroviral-experienced subjects and in those with AZT-resistant
thrombocytopenia. An undetectable plasma HIV viraemia induced by HAART is
necessary for STP recovery. (C) 2001 The British Infection Society.