Risk factors for thrombocytopenia in HIV-infected persons in the era of potent antiretroviral therapy.

Kristen M Marks, Robin M A Clarke, James B Bussel, Andrew H Talal, Marshall J Glesby
Author Information
  1. Kristen M Marks: Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA. markskr@med.cornell.edu

Abstract

OBJECTIVE: Before potent antiretroviral therapy, thrombocytopenia was observed frequently. Little is known about risk factors for or severity and consequences of thrombocytopenia since establishment of highly effective therapy for HIV.
METHODS: We conducted a retrospective-matched case-control study of HIV-infected adult outpatients with and without thrombocytopenia to elucidate the contribution of HIV viremia, hepatitis C infection, and other potential risk factors for thrombocytopenia. Seventy-three cases with thrombocytopenia (platelet count <100 x 10(9)/L persistent for >3 months) were matched by age, sex, and first clinic visit with 73 nonthrombocytopenic controls. Risk factors and outcomes were assessed using conditional logistic regression.
RESULTS: Nadir platelet counts in cases were 400 copies/ml, hepatitis C virus infection, and cirrhosis were significantly associated with thrombocytopenia with adjusted odds ratios of 5.3 [confidence interval (CI) 1.6-17.1, P = 0.006], 6.1 (CI 1.6-22.6, P = 0.007), and 24.0 (CI 1.7-338, P = 0.019), respectively. Thrombocytopenia was significantly associated with major bleeding events and nonbleeding-related death.
CONCLUSIONS: Thrombocytopenia in the era of potent antiretroviral therapy is associated with hepatitis C virus infection, cirrhosis, and uncontrolled HIV replication, and serious complications including major bleeding and death.

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Grants

  1. K23 AI065319-03/NIAID NIH HHS
  2. K24AI078884/NIAID NIH HHS
  3. L30 AI057174-02A1/NIAID NIH HHS
  4. K24 AI078884/NIAID NIH HHS
  5. K23 AI065319/NIAID NIH HHS
  6. L30 AI057174/NIAID NIH HHS
  7. K23 AI065319-05/NIAID NIH HHS
  8. K23 AI065319-02/NIAID NIH HHS
  9. UL1 RR024996/NCRR NIH HHS
  10. K23 AI065319-04/NIAID NIH HHS

MeSH Term

Adolescent
Adult
Anti-HIV Agents
Case-Control Studies
Female
HIV Infections
Hemorrhage
Hepatitis C
Humans
Liver Cirrhosis
Male
Medical Records
Middle Aged
Retrospective Studies
Risk Factors
Thrombocytopenia
United States

Chemicals

Anti-HIV Agents

Word Cloud

Created with Highcharts 10.0.0thrombocytopenia1therapyfactorsHIV0potentantiretroviralhepatitisCinfectionx109/LassociatedCIP=riskHIV-infectedcasesplateletRiskviruscirrhosissignificantly6ThrombocytopeniamajorbleedingdeatheraOBJECTIVE:observedfrequentlyLittleknownseverityconsequencessinceestablishmenthighlyeffectiveMETHODS:conductedretrospective-matchedcase-controlstudyadultoutpatientswithoutelucidatecontributionviremiapotentialSeventy-threecount<100persistent>3monthsmatchedagesexfirstclinicvisit73nonthrombocytopeniccontrolsoutcomesassessedusingconditionallogisticregressionRESULTS:Nadircounts58%38%multivariatemodelingRNA>400copies/mladjustedoddsratios53[confidenceinterval6-17006]6-22007247-338019respectivelyeventsnonbleeding-relatedCONCLUSIONS:uncontrolledreplicationseriouscomplicationsincludingpersons

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