A case series of emtricitabine-induced pure red cell aplasia.
adverse drug reaction
anaemia
antiretroviral
drug induced
emtricitabine
pure red cell aplasia
rare drug toxicity
Journal
Southern African journal of HIV medicine
ISSN: 2078-6751
Titre abrégé: South Afr J HIV Med
Pays: South Africa
ID NLM: 100965417
Informations de publication
Date de publication:
2021
2021
Historique:
received:
20
05
2021
accepted:
29
06
2021
entrez:
15
9
2021
pubmed:
16
9
2021
medline:
16
9
2021
Statut:
epublish
Résumé
Anaemia is common in patients with retroviral disease. New or worsening anaemia after initiation of antiretroviral (ARV) treatment has a broad differential diagnosis. We describe six patients who developed transfusion-dependent anaemia on first-line therapy (tenofovir, emtricitabine and efavirenz) and, by exclusion, implicated emtricitabine in the aetiology of the anaemia. We conducted a retrospective chart review of patients seen at the Infectious Diseases specialist clinic at King Edward VIII Hospital in KwaZulu-Natal between 2014 and 2016. We focused on patients with isolated, refractory and transfusion-dependent anaemia occurring after initiation of ARVs, in whom bone marrow biopsies were consistent with pure red cell aplasia (PRCA) without an identifiable secondary cause. All the patients were female, with a median (range) age and baseline CD4 cell count of 42.5 (23-61) years and 237 (83-329) cells/mm This study provides strong circumstantial evidence that emtricitabine plays an important role in the pathogenesis of reversible PRCA. The mechanisms through which emtricitabine induces PRCA remain unclear and require further study.
Sections du résumé
BACKGROUND
BACKGROUND
Anaemia is common in patients with retroviral disease. New or worsening anaemia after initiation of antiretroviral (ARV) treatment has a broad differential diagnosis.
OBJECTIVES
OBJECTIVE
We describe six patients who developed transfusion-dependent anaemia on first-line therapy (tenofovir, emtricitabine and efavirenz) and, by exclusion, implicated emtricitabine in the aetiology of the anaemia.
METHOD
METHODS
We conducted a retrospective chart review of patients seen at the Infectious Diseases specialist clinic at King Edward VIII Hospital in KwaZulu-Natal between 2014 and 2016. We focused on patients with isolated, refractory and transfusion-dependent anaemia occurring after initiation of ARVs, in whom bone marrow biopsies were consistent with pure red cell aplasia (PRCA) without an identifiable secondary cause.
RESULTS
RESULTS
All the patients were female, with a median (range) age and baseline CD4 cell count of 42.5 (23-61) years and 237 (83-329) cells/mm
CONCLUSION
CONCLUSIONS
This study provides strong circumstantial evidence that emtricitabine plays an important role in the pathogenesis of reversible PRCA. The mechanisms through which emtricitabine induces PRCA remain unclear and require further study.
Identifiants
pubmed: 34522429
doi: 10.4102/sajhivmed.v22i1.1271
pii: HIVMED-22-1271
pmc: PMC8424770
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1271Informations de copyright
© 2021. The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Références
AIDS. 2019 May 1;33(6):1095-1096
pubmed: 30946164
Int J Antimicrob Agents. 2012 Jun;39(6):458-63
pubmed: 22269860
South Afr J HIV Med. 2019 Sep 23;20(1):983
pubmed: 31616574
Proc Natl Acad Sci U S A. 2015 Jul 14;112(28):8596-601
pubmed: 26124101
N Engl J Med. 2004 Feb 5;350(6):586-97
pubmed: 14762186
PLoS One. 2013 Nov 11;8(11):e79981
pubmed: 24244586
Expert Rev Anti Infect Ther. 2004 Feb;2(1):147-51
pubmed: 15482179
AIDS. 1998 Mar 5;12(4):439-40
pubmed: 9520175
J Med Microbiol. 2008 Aug;57(Pt 8):1032-1035
pubmed: 18628508
Am J Hematol. 2000 Nov;65(3):189-91
pubmed: 11074533
AIDS. 1999 Nov 12;13(16):2309-11
pubmed: 10563721
Indian J Dermatol. 2018 Jan-Feb;63(1):18-21
pubmed: 29527021
Intern Med. 2014;53(15):1705-8
pubmed: 25088890