Kakubu Mireille A M, Bikinesi Tarisai, Katoto Patrick D M C
Ministry of Health and Social Services of Namibia, Windhoek, Namibia.
Centre for Tropical Disease and Global Health, School of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
Oxf Med Case Reports. 2023 Mar 25;2023(3):omad022. doi: 10.1093/omcr/omad022. eCollection 2023 Mar.
Adverse effects linked to antiretroviral therapy (ART) may contribute to poor adherence on the patient's side. Consequently, human immunodeficiency virus (HIV) drug resistance mutations could emerge, negatively impacting the body's immune system. Meanwhile, severe immunosuppression can lead to several conditions, including anemia. The cause of anemia in HIV infection is multifactorial, and can be mainly explained by deleterious direct effects of the virus on the bone marrow, and opportunistic infections such as Parvovirus B19. Other causes include blood loss resulting from neoplasms and gastrointestinal lesions. Moreover, anemia can also be caused by antiretroviral drugs. We report a case of persistent anemia after ART initiation, kidney injury and treatment failure following a lengthy period of non-adherence to ART. The anemia was classified as Pure Red Cell Aplasia (PRCA). With treatment modification, the anemia resolved and the patient attained virologic suppression. Lamivudine (3TC) was pointed out as the cause of PRCA, which resolved after its withdrawal from the ART regimen. This rare side effect should be investigated in patients on 3TC who present with recurrent anemia.
与抗逆转录病毒疗法（ART）相关的不良反应可能会导致患者依从性差。因此，可能会出现人类免疫缺陷病毒（HIV）耐药性突变，对人体免疫系统产生负面影响。同时，严重的免疫抑制会导致多种病症，包括贫血。HIV感染中贫血的病因是多方面的，主要可由病毒对骨髓的有害直接作用以及细小病毒B19等机会性感染来解释。其他原因包括肿瘤和胃肠道病变导致的失血。此外，贫血也可能由抗逆转录病毒药物引起。我们报告了一例在开始ART后出现持续性贫血、长期不坚持ART治疗后出现肾损伤和治疗失败的病例。该贫血被归类为纯红细胞再生障碍性贫血（PRCA）。通过调整治疗方案，贫血得到缓解，患者实现了病毒学抑制。拉米夫定（3TC）被指出是PRCA的病因，在将其从ART方案中停用后PRCA得以解决。对于出现反复贫血的服用3TC的患者，应调查这种罕见的副作用。
