Petrenko A A, Dudina G A, Kremneva N V, Pivnik A V
Loginov Moscow Clinical Scientific Center.
People's Friendship University of Russia.
Ter Arkh. 2020 Sep 1;92(7):100-103. doi: 10.26442/00403660.2020.07.000651.
Here we provide a review of the literature and a description of our own clinical case. The patient was a 32-year-old woman who had been infected with HIV for 6 years without antiretroviral therapy. The test results showed CD4 87 cells/l, viral load 3750 copies/ml. Normochromic normocytic anemia and reticulocytopenia developed soon. In the myelogram, all erythroblasts were 0.5%. The viral load of parvovirus B19 DNA according to PCR was more than 9 million IU/ml. Pure red cell aplasia associated with parvovirus B19 was diagnosed. We started antiretroviral therapy with efavirenz, lamevudine and tenofovir. In addition to blood transfusions, we administered intravenous donor immunoglobulin with a dose increase from 5000 mg to 20 000 mg per day. After discontinuing of intravenous immunoglobulins, the laboratory test results were stable over the next 5 months: hemoglobin was more than 115 g/L, reticulocytes more than 3%, in the myelogram all erythroblasts were 21%. However, the elimination of parvovirus B19 wasnt achieved. The maximum decrease in viral load for parvovirus B19 was down to 720 IU/ml. A typical feature of the case was the lack of pure red cell aplasia of the bone marrow with the existing viral load of parvovirus B19. HIV infection progressed: 44 cells/l, viral load not determined. The case ended lethally.
在此，我们对文献进行综述并描述我们自己的临床病例。患者为一名32岁女性，感染HIV达6年，未接受抗逆转录病毒治疗。检测结果显示CD4细胞计数为87个/微升，病毒载量为3750拷贝/毫升。不久后出现正细胞正色素性贫血和网织红细胞减少。骨髓检查中，所有早幼红细胞为0.5%。根据PCR检测，细小病毒B19 DNA的病毒载量超过900万国际单位/毫升。诊断为与细小病毒B19相关的纯红细胞再生障碍性贫血。我们开始使用依非韦伦、拉米夫定和替诺福韦进行抗逆转录病毒治疗。除输血外，我们每天静脉输注供体免疫球蛋白，剂量从5000毫克增加到20000毫克。停止静脉输注免疫球蛋白后，接下来5个月实验室检测结果稳定：血红蛋白超过115克/升，网织红细胞超过3%，骨髓检查中所有早幼红细胞为21%。然而，细小病毒B19未被清除。细小病毒B19病毒载量的最大降幅降至720国际单位/毫升。该病例的一个典型特征是在存在细小病毒B19病毒载量的情况下，骨髓缺乏纯红细胞再生障碍。HIV感染进展：CD4细胞计数为44个/微升，病毒载量未测定。该病例最终致命。
