Haematological disorders in people with HIV infection

Sam Milliken              Department of Clinical Haematology and HIV Medicine Clinical Services Units, St Vincent’s Hospital, Sydney, NSW Last reviewed: October 2019 Introduction Despite significant reductions in all complications of HIV infection since the introduction of combination antiretroviral therapy (cART), haematological disorders remain common.1 Common problems are cytopenias, dysproteinaemia, lymphadenopathy and splenomegaly, and thromboembolic disease. The majority …

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Anaemia is a common problem and increases in frequency with stage of HIV infection, ranging from 3% of asymptomatic patients to 12% of patients with CD4+ T cell counts of <200 cells/μL (or a CD4+ T cell percentage of <14% of lymphocytes) and 37% of patients with the acquired  immunodeficiency syndrome (AIDS) in one large surveillance study.3 Anaemia has been associated with reduced survival in …

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Thrombocytopenia is commonly observed in people with HIV infection with immune thrombocytopenic purpura (ITP) the most common cause of severe thrombocytopenia (platelet count < 30 x 10^9/L). It may occur in 30% or more of patients with AIDS13 and can occur at any time during HIV infection. In the antiretroviral era, risk factors include HIV viral load …

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Neutropenia is common in HIV infection (16% of patients in one study of over 130,00 individuals in a primary care setting) and should trigger testing for HIV infection. 18 Neutropenia may be due to HIV infection itself, autoimmune neutropenia, infections such as MAC and tuberculosis (TB), marrow infiltration by malignancy (commonly lymphoma), hypersplenism and drugs.  Treatment  …

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An increase in immunoglobulin production occurs as part of the immune dysfunction caused by HIV infection and monoclonal paraproteins have been reported in as many as 7% of people with HIV infection. They do not appear to be clinically significant and may persist despite ART.20 Similarly, cryoglobulinaemia has been reported in HIV infection, again without clinical significance. Over 90% …

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 Thrombosis has been reported in up to 2% of people with HIV infection.  Risk factors for this group  are  age over 45 years, advanced  stage of HIV infection,  co-existing  opportunistic infections,  hospitalisation,  and therapy  with indinavir  and megestrol acetate.22  A number of potentially pro-thrombotic abnormalities  have  been reported  in association with HIV infection, including decreased …

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Bone marrow examination should be undertaken for any unexplained moderate-to-severe anaemia or isolated cytopenia or pancytopenia and for pyrexia of unknown origin where initial tests are unhelpful. Specimens should be sent for special microbial cultures, such as MAC, flow cytometry to examine to help exclude lymphoma, as well as for morphological examination.

Volberding PA, Baker KR, Levine AM.  Human immune deficiency virus hematology. Hematology 2003; 2003:294-313. Choi SY, Kim I, Kim NJ et al. Hematological manifestations of human immunodeficiency virus infection and the effect of highly active anti-retroviral therapy on cytopenia. Korean J Hematol 2011; 46:253. Sullivan PS, Hanson DL, Chu SY et al.. Epidemiology of anemia …

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