HIV-associated thrombotic thrombocytopaenic purpura: A retrospective cohort study during the anti-retroviral therapy era.

BACKGROUND: HIV-associated thrombotic thrombocytopaenic purpura (TTP) is thought to represent the majority of current TTP diagnoses in South Africa (SA).

AIM: The primary aim was to describe the clinical features and compare the time to remission of TTP in those patients with and without HIV.

DESIGN: A retrospective cohort study conducted at Tygerberg Hospital in Cape Town, SA for the period January 1, 2010 to January 31, 2015.

METHODS: All adult patients requiring ≥5 units of plasma products for ≥1 day during hospitalization were screened for a diagnosis of TTP. Those with a reported clinical diagnosis and/or laboratory evidence of TTP were included in the final analysis.

RESULTS: A total of 52 cases were identified of which 78.8% were HIV-infected. Time to remission was 10 days in the HIV group vs 19 days in the HIV negative group, P = 0.07. Most of the patients were Black females. Fever was more common in those with HIV. Neurological features were common in both groups. The majority in the HIV group was managed exclusively with plasma infusion alone (90.2% vs 45.5%, P < 0.01). There were no differences in the time to remission regardless of treatments received. Anti-retroviral therapy initiation during hospitalization was a predictor for remission. Overall mortality rate was 44.2%.

CONCLUSION: There was no difference in the time to remission in patients with HIV-associated TTP as compared with HIV negative TTP. The high mortality was probably the result of less intensive plasma infusion and therapeutic plasma exchange regimens.