Thrombocytopenic purpura as first manifestation of human immunodeficiency virus type I (HIV-1) infection
Hollak, C.E.; Kersten, M.J.; van der Lelie, J.; Lange, J.M.
Netherlands Journal of Medicine 37(1-2): 63-68
1990
ISSN/ISBN: 0300-2977 PMID: 2215837 Document Number: 352838
We report three cases of thrombocytopenic purpura associated with HIV-1 infection. The clinical picture is indistinguisable from classic autoimmune thrombocytopenic purpura (AITP). All three patients initially responded to treatment with high dose methylprednisolone. One patient had an incomplete remission on low dose prednison, while another responded to zidovudine treatment. The third patient uderwent splenectomy because he showed no response to treatment with low dose prednisone or zidovudine. The pathogenesis of HIV-associated thrombocytopenic purpura (HIV-TP) is still controversial. Two hypotheses are frequently mentioned: non-specific deposition of circulating immune complexes and complement versus specific auto-antibodies against platelets are suggested to be the cause of the increased clearance of platelets. In cases of severe thrombocytopenia, the therapy of first choice is initial high dose methylprednisolone, followed by either low dose prednisone in the presence of a relatively unaffected cellular immunity, or zidovudine, when the cellular immunity is already severely impaired.