Immune reconstitution to parvovirus B19 and resolution of anemia in a patient treated with highly active antiretroviral therapy |
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Authors: | Dai Watanabe Tomohiro Taniguchi Naruhito Otani Shinjiro Tominari Yasuharu Nishida Tomoko Uehira Takuma Shirasaka |
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Institution: | (1) AIDS Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka Osaka, 540-0006, Japan |
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Abstract: | Immune reconstitution inflammatory syndrome (IRIS) is an unsolved problem in the treatment of human immunodeficiency virus
(HIV)-1 infection. Despite the high seroprevalence of parvovirus B19 (PVB19) among HIV-1-positive patients, reports on PVB19-induced
anemia, especially that associated with PVB19-related IRIS, in these patients are limited. We present the case of a man with
acquired immunodeficiency syndrome who developed severe transfusion-dependent anemia and was seropositive and borderline positive
for immunoglobulin-M and IgG antibodies against PVB19, respectively. PVB19-DNA was also detected in his serum. The patient
was diagnosed with pure red cell anemia (PRCA) caused by a primary PVB19 infection and was treated with periodical blood transfusions.
However, he subsequently tested negative for IgG antibodies and developed chronic severe anemia with high levels of PVB19
viremia. This indicated a transition from primary to persistent infection. After initiation of highly active antiretroviral
therapy, the patient showed an inflammatory reaction with rapid deterioration of anemia and seroconversion of the IgG antibody
to PVB19. Subsequently, PRCA was completely resolved, but the patient’s serum still contained low levels of PVB19-DNA. Thus,
this was a case of IRIS associated with PVB19 infection. Our report highlights the significance of seroconversion to PVB19
in the diagnosis of IRIS and re-emphasizes the finding that persistently high levels of PVB19 viremia after primary infection
are probably because of the lack of protective antibodies. |
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Keywords: | HIV-1 infection Parvovirus B19 Pure red cell anemia Immune reconstitution inflammatory syndrome |
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