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HIV associated thrombotic microangiopathy

¹ Division of Hematology and Oncology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, the Long Island Campus for the Albert Einstein College of Medicine, Bronx, New York
² Division of Pulmonary and Critical Care Medicine
³ Division of Infectious Diseases
⁴ Department of Pathology, St Luke’s Roosevelt Hospital, New York

Correspondence to:
Dr Joseph Cervia, Division of Infectious Disease, Staff House, Suit 226, Long Island Jewish Medical Center, 270–05 76th Avenue, New Hyde Park, NY 11040, USA;
cervia{at}lij.edu

Thrombotic microangiopathy (TMA) is a known complication of HIV infection. Endothelial cell injury appears to be the primary event causing platelet activation and deposition in the microvasculature. Direct cytopathic roles of HIV as well as other factors such as malignancy, drugs, and infectious agents have been implicated in the pathogenesis of HIV-TMA. Although the the majority of patients present in a more advanced stage of HIV disease, TMA can be the initial presenting symptom of HIV infection. Clinical features are those of idiopathic TMA, and the diagnosis should be suspected in any patient with new onset thrombocytopenia and microangiopathic haemolytic anaemia. Therapy with plasma exchange or infusion appears to be efficacious. A rapid diagnosis and institution of plasmapheresis is crucial for a favourable outcome. The long term prognosis of HIV-TMA is unfavourable and may depend on the stage of HIV infection. The recent data after the use of highly active retroviral treatment, however, are unavailable and current prognosis is therefore uncertain.

Keywords: thrombotic microangiopathy; HIV infection; haemolytic uraemic syndrome; thrombotic thrombocytopenic purpura

Abbreviations: HUS, haemolytic uraemic syndrome; TMA, thrombotic microangiopathy; TTP, thrombotic thrombocytopenic purpura

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