HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: An observational study

The prevalence and predisposing factors of thrombotic microangiopathy (TMA) in the era of highly active antiretroviral therapy ( HAART) were evaluated among patients in the Collaborations in Human Immunodeficiency Virus (HIV) Outcomes Research/US cohort. Of 6022 patients, 17 (0.3%) had TMA, with unadjusted incidences per 100 person-years of 0.079 for TMA, 0.009 for thrombotic thrombocytopenic purpura, and 0.069 for hemolytic-uremic syndrome. Compared with patients without TMA, patients with TMA had lower mean CD4(+) cell counts (197 vs. 439 cells/mm(3); P = .0009) and higher mean log(10) HIV-1 RNA levels (4.6 vs. 3.3 copies/mL; P = .0001) at last follow-up and a significantly greater incidence of acquired immune deficiency syndrome (82.4% vs. 55.3%; P = .025), Mycobacterium avium complex infection (17.6% vs. 3.3%; P = .018), hepatitis C (29.4% vs. 11.3%; P = .001), and death (41.2% vs. 7.4%; P < .0001). The prevalence of herpes and use of antiherpetics were slightly higher for patients with TMA, but unadjusted distributions were not statistically significant. TMA in a cohort surveyed after the introduction of HAART was rare and was associated with advanced HIV disease.