Long and short term side effects of antiretroviral medicines are not

Long and short term side effects of antiretroviral medicines are not fully understood yet. In order to prevent HIV illness post exposure prophylaxis (PEP) is considered in situations with potential risk of illness [1 2 Long and short term side effects of the medicines used are not fully understood yet. Here we statement a case of reversible leukopenia and thrombocytopenia following a 28? days course of post exposure prophylaxis with tenofovir/emtricitabin and lopinavir/ritonavir. Case demonstration A 56?years old male patient presented after occupational needle prick injury. Index patient could not be identified and PEP was started SU6668 within 28?hours with lopinavir 400?mg/ritonavir 100?mg BD and tenofovir 245?mg/emtricitabin 200?mg QD and was continued for 28?days. Serology for HIV HCV HBV as well as guidelines for blood count (leukocytes 4.6 Gpt/l thrombocytes 146 Gpt/l) liver and renal function checks were unremarkable. Hepatitis B vaccination was given. Past medical history revealed coronary heart disease hypertension and the patient reported known marginal reduction of platelets SU6668 in absence of any hemic disease. The concurrent medication consisted of ramipril 5?mg QD acetylsalicylacid 100?mg QD and simvastatin 40?mg QD. The statin was paused during PEP. Antiretroviral post exposure treatment was clinically well tolerated and the patient reported no symptoms of rash or gastrointestinal side effects. Control of laboratory parameters on day time 19 after initiation of PEP showed a slight decrease in WBC to 4.0 Gpt/l. Investigation on day time 33 (5?days after the end of PEP) showed bicytopenia with leukopenia 2.0 Gpt/l and thrombocytopenia 97 Gpt/l. A second control on day time 40 exposed a return to a normal blood count and no alterations of differential blood count (neutrophil granulocytes 3.61 Gpt/l lymphocytes 1.46 Gpt/l monocytes 0.39 Gpt/l eosinophil granulocytes 0.06 Gpt/l basophil granulocytes 0.02 Gpt/l). Serum electrophoresis was unremarkable (total protein 70.4?g/l albumin 66.9% alpha-1-globulin 3.6% alpha-2-globulin 8.4% beta-globulin 9.7% gamma-globulin 11.4%) and dedication of ANA and pANCA as well as folic acid and vitamin B 12 levels revealed normal ideals. There was no evidence of blood count changes during follow up over 6?weeks and the patient remained sero-negative for HIV and HCV. After stratification of benefits and risks no further invasive clarification of pathogenicity was initiated. Conclusions Cytopenia such as anemia thrombocytopenia neutropenia or lymphopenia is definitely a known effect of HIV and AIDS status is an recognized risk factor. SU6668 A recent Korean publication pointed out the effect of HIV only on hematologic manifestations. With this study cytopenia was shown to be reversible with antiretroviral treatment [3]. Thrombocytopenia or leukopenia following antiretroviral post exposure Rabbit Polyclonal to TPD54. therapy with tenofovir or emtricitabin have not been explained yet. Inside a retrospective study leukopenia was associated with lopinavir/ritonavir [4]. A thorough review revealed a single case of thrombocytopenia associated with lopinavir/ritonavir [5]. Like a mechanism of pathogenicity autoimmune causes can be discussed for thrombocytopenia in our case. Since ANA and SU6668 ANCA were tested bad this hypothesis is definitely less convincible. As leukopenia emerged simultaneously to thrombocytopenia a direct impact on hematopoiesis seems more plausible. Thrombocytopenia was explained for additional protease inhibitors such as saquinavir but to this date no feasible hypothesis for pathogenicity is definitely available [6]. Based on earlier observations and this case statement we propose that antiretroviral medicines used in PEP may have a direct impact on hematopoiesis. The precise mechanism should be further investigated. Consent Written educated SU6668 consent was from the patient for publication of this case statement. A copy of the written consent is available for review from the Editor-in-Chief of this journal. Abbreviations AIDS: Acquired immunodeficiency syndrome; ANA: Anti-nuclear antibody; ANCA: Anti-neutrophil cytoplasmic antibody; HBV: Hepatitis B disease; HCV: Hepatitis C disease; HIV: Human being immunodeficiency.