Thrombopoeitin agonists appear effective in HIV-related thrombocytopenia

Thrombopoeitin agonists (TA) appear to be effective in HIV-related thrombocytopenia (HIV-TP) patients who have been refractory to standard treatments, Roberto Ochoa, MD, and colleagues at the University of Miami report. 

Clinicians there treated five patients (mean age 48, four males) with HIV-ITP with thrombopoeitin agonists from 2009 to 2011. All of the patients had failed or relapsed after prednisone. Three of the patients had also failed multiple treatments including splenectomy (1 patient), IVIG, Rho(D) immune globulin, rituximab, danazole, and vincristine.  All but one of the patients were on HAART by the time of treatment; CD4 counts were <200 cells/µL in two patients. 

All five patients were treated initially with romiplostim at a starting dose of 1 mcg/Kg and titrated according to guidelines. One patient requested to be switched to eltrombopag and developed complications one week later.

The mean baseline platelet count was 27 x 103/µL (13-40 x 103/µL) and increased to 66 x 103/µL (45-86 x 103/µL) within one week and 76 x 103/µL (45-107 x 103/µL) after one month, 2.8 times the baseline (2.1 – 3.4 x baseline value).  Four patients achieved a platelet count >/=50 x 103/µL within one month. 

Four of the patients had durable responses for >/=12 months and did not need dose adjustments or modifications. One patient, who had several compliance issues and had missed several doses of romiplostim, showed improved platelet count every time the medication was restarted. 

The authors said that this is the first report, “of the successful and sustained use of TA in patient with HIV-ITP.”