Exacerbation of microcytic anemia associated with cessation of anti-retroviral therapy in an HIV-1-infected patient with beta thalassemia |
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| Institution: | 1. Division of Blood Transfusion Medicine and Cell Therapy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan;2. Laboratory and Vascular Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan;3. Internal Medicine, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan;4. Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medicine and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan;1. Cincinnati Children''s Hospital Medical Center, Department of Radiology, 3333 Burnet Avenue, MLC 5031;2. Center for Epidemiology and Biostatistics, Cincinnati, OH 45229;3. Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710;4. Phoenix Children''s Hospital Department of Radiology, 1919 East Thomas Road, Phoenix, AZ 85016;5. Toshiba America Medical Systems, Tustin, CA;6. Radiation Safety Division, Duke University Medical Center, Durham, NC;7. College of Medicine, University of Cincinnati, Cincinnati, OH;1. Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan;2. Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan;3. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan;4. Department of Respiratory Medicine, Toyota Kosei Hospital, Toyota, Japan;5. Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan;6. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan;7. Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan;8. Division of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan;9. Department of Biomedical Sciences, Chubu University, Kasugai, Japan;1. Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan;2. Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;3. Department of Molecular Pathology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;4. Center for Biological Resources and Informatics, Dainichiseika-Donated Chair of Research Division for Innovative Biomaterials, Tokyo Institute of Technology, 4359 Nagatsuta-cho, Midori-ku, Yokohama 226-8503, Japan;5. Animal Medical Center, Faculty of Agriculture, Tottori Univ.4-101, Koyama-chou Minami, Tottori, Japan;1. Laboratory for Experimental Immunology of the Eye, Department of Ophthalmology, University of Cologne, Cologne, Germany;2. Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany;3. Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany;4. Institute for Medical Microbiology, Immunology and Hygiene and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany;1. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Japan;2. Japan Society for the Promotion of Science, Japan;3. Ashikaga Red Cross Hospital, Japan;4. Department of Practical Pharmacy, Keio University Faculty of Pharmacy, Japan;5. Fuji Heavy Industries Health Insurance Society Ota Memorial Hospital, Japan;6. Center for Infection Control, Toho University School of Medicine, Japan;7. Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Japan |
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| Abstract: | We report a patient with Japanese minor β thalassemia and HIV-1 infection.The patient showed prolonged anemia, which was originally attributed to chronic parvovirus B19 infection. Twelve years later, the patient presented with exacerbation of microcytic anemia following cessation of anti-retroviral therapy; the exacerbation resolved when anti-retroviral therapy was resumed. Sequencing of the β globin gene revealed heterozygosity for a four-nucleotides deletion at codon 41/42 and minor β thalassemia was confirmed.Because HIV-1-infected patients frequently show anemia due to nutritional deficiencies, opportunistic infections, AIDS-related malignancies, drug treatment and a direct effect of HIV-1 on the bone marrow, it is likely to overlook other causes of anemia.Thalassemia should be considered in the differential diagnosis of anemia even in HIV-1 infected patients, when microcytic anemia without iron deficiency is observed.Our case suggested that active HIV infection may have worsened β thalassemia, and early introduction of anti-retroviral therapy is beneficial for the recovery of anemia. |
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| Keywords: | HIV infection Exacerbation of anemia Cessation of ART Beta thalassemia |
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