Drug-induced immune hemolytic anemia because of efavirenz: a case report

作者：Kyaw San Lin, Sein Win, Phyo Pyae Nyein · 发表于：AIDS · 年份：2019 · DOI：10.1097/qad.0000000000002425 · 被引用次数：8 · 研究领域：Blood groups and transfusion、HIV/AIDS drug development and treatment、HIV Research and Treatment

Current medical literature does neither list autoimmune hemolytic anemia (AIHA) under efavirenz (EFV) side effects [1], nor EFV under drugs causing drug-induced immune hemolytic anemia (DIIHA) [2]. Until recently, there was only one case report of hemolytic anemia associated with EFV [3]. We report a case of DIIHA in which EFV was diagnosed, by a strong temporal relationship with AIHA, to be the causal agent. A 50-year-old lady was diagnosed to be HIV-infected in 2007 at the age of 39 years and initiated ART in 2012. Her CD4+ count before ART was 257 cells/μl. She had no major opportunistic infections. ART was substituted for twice, from stavudine/lamivudine/nevirapine to tenofovir/lamivudine/nevirapine in 2014 because of stavudine phase-out and from tenofovir/lamivudine/nevirapine to tenofovir/lamivudine/efavirenz in 2015 for treatment simplification. HIV RNA was undetectable (<40 copies/ml) and CD4+ increased to 688 cells/μl in 2016. She did not experience any side effects of ART (Table 1).Table 1: Hemoglobin level and antiretroviral therapy regimen.In January 2018, she became increasingly breathless even on slight exertion and family members were concerned about her becoming pale and frail. Therefore, she was admitted to Yangon General Hospital. Physical examination revealed marked pallor and tachycardia, but her spleen was not palpable. On admission (15 January 2018), her hemoglobin (Hb) was 3.3 g/dl, with mean corpuscular volume 102 fl, white cell count 21.3 × 109/l and ...