Zhou Jing, Wang Qi, Yu Yu'e, Chen Lingling, Shi Jinchuan, Huang Congxiang, Zhuang Rangxiao
Department of Pharmacy, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, China.
Department II of Infectious Disease, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, China.
BMC Infect Dis. 2024 Dec 18;24(1):1421. doi: 10.1186/s12879-024-09875-z.
Zidovudine is an antiviral drug used to treat acquired immune deficiency syndrome (AIDS). Anaemia is a common adverse effect of zidovudine that usually occurs in the first 2 to 4 weeks of initial treatment. Here, we describe a patient with HIV infection who developed severe aplastic anaemia 11 years after taking zidovudine. To our knowledge, this is the first case of severe aplastic anaemia caused by the long-term use of zidovudine.
A 28-year-old male patient with AIDS developed severe aplastic anaemia after taking zidovudine for 11 years. The patient went to the emergency department due to weakness and falls. He was diagnosed with severe anaemia because his haemoglobin (Hb) level was 31 g/L and his red blood cell (RBC) count was 0.89 × 10/L. Gastrointestinal bleeding, haematological diseases and autoimmune haemolytic anaemia were ruled out by gastroenteroscopy, stool routine examination and bone marrow puncture biopsy after admission. When the causality of adverse drug reactions was assessed, the Naranjo score of zidovudine was 8, indicating that severe aplastic anaemia was likely related to zidovudine. Given that bone marrow suppression is a side effect of zidovudine, this drug was discontinued. Lamivudine and dolutegravir sodium tablets were subsequently used as antiviral therapies. The patient's symptoms of anaemia improved with the transfusion of suspended RBCs, oral polysaccharide iron complex capsules and folic acid tablets. After 2 weeks of treatment, the patient's symptoms of fatigue improved, with a Hb level of 70 g/L and a RBC count of 2.13 × 10/L, which were significantly better than before, and he was discharged. At the follow-up 6 weeks after discharge, the patient's Hb level was 156 g/L, his RBC count was 4.67 × 10/L, and the anaemia was resolved.
Zidovudine has bone marrow suppression toxicity, which manifests as anaemia and can occur at any stage of use. Thus, we should not only pay attention to the initial stage of medication but also regularly monitor the patient via routine blood tests in the later stage. If anaemia occurs during the use of zidovudine, physicians should consider the possibility that anaemia is related to the administration of zidovudine and prescribe medication cessation and symptomatic treatment.
齐多夫定是一种用于治疗获得性免疫缺陷综合征（艾滋病）的抗病毒药物。贫血是齐多夫定常见的不良反应，通常发生在初始治疗的前2至4周。在此，我们描述了一名感染HIV的患者，在服用齐多夫定11年后发生了严重再生障碍性贫血。据我们所知，这是首例因长期使用齐多夫定导致严重再生障碍性贫血的病例。
一名28岁的艾滋病男性患者在服用齐多夫定11年后发生了严重再生障碍性贫血。患者因虚弱和跌倒前往急诊科。他被诊断为严重贫血，因为其血红蛋白（Hb）水平为31g/L，红细胞（RBC）计数为0.89×10/L。入院后通过胃镜检查、大便常规检查及骨髓穿刺活检排除了胃肠道出血、血液系统疾病及自身免疫性溶血性贫血。在评估药物不良反应的因果关系时，齐多夫定的纳伦霍评分（Naranjo score）为8分，表明严重再生障碍性贫血可能与齐多夫定有关。鉴于骨髓抑制是齐多夫定的副作用，停用了该药物。随后使用拉米夫定和多替拉韦钠片作为抗病毒治疗。通过输注悬浮红细胞、口服多糖铁复合物胶囊和叶酸片，患者的贫血症状有所改善。治疗2周后，患者的乏力症状改善，Hb水平为70g/L，RBC计数为2.13×10/L，明显优于治疗前，随后出院。出院后6周随访时，患者的Hb水平为156g/L，RBC计数为4.67×10/L，贫血得到缓解。
齐多夫定具有骨髓抑制毒性，表现为贫血，可在使用的任何阶段发生。因此，我们不仅要关注用药初期，后期也应定期通过血常规检查对患者进行监测。如果在使用齐多夫定期间发生贫血，医生应考虑贫血与齐多夫定给药有关的可能性，并进行停药及对症治疗。
