HIV-Associated Thrombotic Thrombocytopenic Purpura (HIV-TTP)

A Practical Guide and Review of the Literature

Susan Louw; Barry Frank Jacobson; Tracey Monica Wiggill; Zivanai Chapanduka; Elizabeth Sarah Mayne

Disclosures

HIV Medicine. 2022;23(10):1033-1040. 

In This Article

Abstract and Introduction

Abstract

Background: Thrombotic thrombocytopenic purpura (TTP), a serious thrombotic microangiopathy (TMA), is prevalent in the South African HIV-infected population. The exact pathogenesis of HIV-associated TTP (HIV-TTP) is however still unclear with diagnostic and therapeutic inconsistancies.

Methods: A systematic review of the published literature regarding HIV-TTP was performed.

Results: HIV-TTP is still associated with significant morbidity and mortality in Africa despite the availability of anti-retroviral therpy (ART). Diagnosis of HIV-TTP requires the presence of a micro-angiopathic haemolytic anaemia with significant red blood cell schistocytes and thrombocytopenia in the absence of another TMA but background activation of the coagulation system and inflammation in HIV infected people can result in diagnostic anbiguity. Plasma therapy in the form of infusion or exchange is successful but expensive, associated with side-effects and not widely available. Adjuvant immunosuppression therapy may of benefit in patients with HIV-TTP and ART must always be optimised. Endothelial dysfunction caused by chronic inflammation and complement activation most likely contributes to the development of HIV-TTP.

Conclusion: The role of adjuvant immunomodulating therpy, the therapeutic targets and pathogenic contribution from endothelial dysfunction in HIV-TTP requires further investigation.

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