Pancytopenia in HIV-positive patients with congestive heart failure: mechanisms, diagnosis, and treatment approaches.

Pancytopenia, characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets, is a significant hematological complication in individuals living with human immunodeficiency virus (HIV). Its presence often reflects disease progression, immune suppression, and concurrent opportunistic infections. When pancytopenia coexists with congestive heart failure (CHF) - a condition increasingly prevalent among HIV-positive patients due to chronic inflammation, antiretroviral therapy (ART)-associated cardiotoxicity, and aging - the clinical burden intensifies, leading to diagnostic and therapeutic dilemmas. This review aims to examine the underlying mechanisms, diagnostic challenges, and management strategies of pancytopenia in HIV-positive patients with CHF. It explores the multifactorial pathophysiology, including direct viral effects on the bone marrow, drug-induced cytopenias, opportunistic infections, nutritional deficiencies, and CHF-related impairments in erythropoietin and thrombopoietin production. Additionally, the review highlights overlapping symptoms that complicate diagnosis and evaluates current treatment options ranging from ART optimization to hematopoietic growth factors and supportive care.