Obeagu Emmanuel Ifeanyi, Goryacheva Olga G
Department of Biomedical and Laboratory Science, Africa University, Mutare, Zimbabwe.
Department of Polyclinic Therapy, Perm State Medical University named after Academician E.A. Wagner, Ministry of Health of the Russian Federation, Perm, Russian Federation.
Ann Med Surg (Lond). 2025 Jun 16;87(9):5624-5630. doi: 10.1097/MS9.0000000000003501. eCollection 2025 Sep.
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.
全血细胞减少症的特征是红细胞、白细胞和血小板同时减少，是人类免疫缺陷病毒（HIV）感染者中一种严重的血液学并发症。它的出现往往反映了疾病进展、免疫抑制以及并发的机会性感染。当全血细胞减少症与充血性心力衰竭（CHF）并存时——由于慢性炎症、抗逆转录病毒疗法（ART）相关的心脏毒性以及衰老，这种情况在HIV阳性患者中越来越普遍——临床负担加重，导致诊断和治疗困境。本综述旨在探讨合并CHF的HIV阳性患者全血细胞减少症的潜在机制、诊断挑战和管理策略。它探讨了多因素病理生理学，包括病毒对骨髓的直接影响、药物性血细胞减少、机会性感染、营养缺乏以及CHF相关的促红细胞生成素和血小板生成素生成受损。此外，该综述强调了使诊断复杂化的重叠症状，并评估了从优化ART到造血生长因子和支持性护理等当前的治疗选择。
