[Human immunodeficiency virus-associated thrombotic microangiopathies].

Abstract

Human immunodeficiency virus (HIV) infection represents a risk factor for thrombotic microangiopathy. HIV-associated thrombotic microangiopathies encompass two entities with distinct pathophysiology, clinical presentation, treatment and prognosis. Thrombotic thrombocytopenic purpura associated with human immunodeficiency virus is typically characterized by a sudden onset in a patient with a moderate immune deficiency and a few events of opportunistic diseases, and a profound acquired deficiency in the von Willebrand factor cleaving protease ADAMTS13. This diagnosis requires a well-codified management including daily therapeutic plasma exchanges, a highly active antiretroviral therapy and eventually immunomodulatory drugs. The prognosis is good with a response rate and an overall survival comparable to that of HIV-negative thrombotic thrombocytopenic purpura. On the opposite, HIV-associated thrombotic microangiopathy with a progressive onset that occurs in profoundly immunocompromised patients with past history of multiple opportunistic diseases usually have a detectable ADAMTS13 activity and a worse prognosis. Usual treatment is poorly efficient. Forthcoming studies should assess the role of immunomodulatory drugs such as rituximab in the setting of HIV-associated thrombotic microangiopathy, and identify possible risk factors associated with the occurrence of these diseases.

• Authors: L Gilardin, S Malak, Y Schoindre, L Galicier, A Veyradier, P Coppo
• Journal: La Revue de medecine interne (Rev Med Interne) Vol. 33 Issue 5 Pg. 259-64 (May 2012) ISSN: 1768-3122 [Electronic] France
• Vernacular Title: Purpura thrombotique thrombocytopénique et autres syndromes de microangiopathie thrombotique au cours de l'infection par le virus de l'immunodéficience humaine.
• PMID: 22280852 (Publication Type: English Abstract, Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Topics

• HIV Infections (complications)
• Humans
• Prognosis
• Thrombotic Microangiopathies (diagnosis, etiology, physiopathology, therapy)