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ITP while on HAART

Dec 18, 2013

Dear Nelson, thanks again to you and all the crew at The Body for the invaluable help and hope you are giving to all of us. I was wondering if you can help me with the following:

I am a 40 year old man, HIV+ for 4 years and on HAART for nearly 3 years. I have CD4 of approx. 350 (38%) and undetectable virus load. However, I have been diagnosed with falling platelet count which went from 200 last December to 90 in April, 70 in September and only 30 now. I also have some symptoms including frequent bruising. I understand that thrombocytopenia is common for HIV+ people but usually when they are not on a successful HAART regime. I am feeling generally OK although my other blood results are also been getting worse and I have currently low hemoglobin (11.3), low red blood cells (3.9) and low white cells too (4.2). My doctor thinks I have ITP and has suggested treatment with intravenous immune globulin although I am wondering why the rest of my blood indicators have also worsened. An Elisa test for platelet antibodies came negative...

How common is HIV related ITP for people with undetectable virus load and what is the long term prognosis? I understand that the IVIG treatment is helping only with the symptoms and not the underlying cause. Does this mean that I will have this problem for the rest of my life? I really hope to avoid splenectomy which I understand would significantly reduce my life expectancy...

Thanks so much for your help

Response from Dr. Henry

Idiopathic thombocytopenia purpura (ITP) has been linked to HIV infection and has been seemingly less common on the modern treatment era but is still see. Platelet counts < 30,000 are often relatively well tolerated. If treated with effective HIV medication doesnt result in a trend towards improved platelet counts and the platelet count persists at a worrisome level << 30,000 then use of immunoglobulin and/or steroid treatment is considered (severe cases splenectomy is a consideration as well). Experience about any differential effect of good HAART regimens on platelet counts in ITP is limited with much of the data based on old studies with AZT (zidovudine). KH

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