Presentation of HIV-associated thrombotic thrombocytopaenic purpura and response to plasma exchange: a 10-year retrospective single-centre experience

Abstract

Background HIV is an important cause of thrombotic thrombocytopenic purpura (TTP) in the local context. The presentation, mortality, and renal outcomes of HIV-associated TTP (HIV- TTP) remain poorly characterized, and the role of plasma exchange (PEX) as a treatment strategy is largely unreported. Methods We retrospectively reviewed 105 cases of HIV-TTP treated with PEX between 1/1/2010 – 31/12/2020. The presentation, and mortality and renal outcomes of this cohort are described, and complications of PEX therapy are characterised. The effect of HIV infection severity on HIV-TTP presentation, and the effect of both these parameters on mortality, PEX complications, and renal outcomes are analysed using appropriate regression models. Results There is an association between advanced HIV infection and HIV-TTP and there is a predilection for young Black women. Neurological deficit is a common presenting feature. Severity of HIV infection may influence renal dysfunction at presentation; this in turn may affect survival outcomes on PEX as may choice of plasma infusant. HIV- TTP carries significant mortality risk; sepsis is a notable contributor to mortality in HIV-TTP treated with PEX. Residual renal impairment is uncommon in the survivors of HIV-TTP. 5 Conclusions Mortality remains high in HIV-TTP treated with PEX, and sepsis-related complications are of concern. Randomized prospective studies are required to evaluate the use of PEX versus plasma infusion (PI) and infusant choice in HIV-TTP. Longer duration follow-up studies are needed to evaluate residual renal impairment in survivors of HIV-TTP.