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Immune thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection

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Abstract

Little research focuses on the association between immune thrombocytopenic purpura and human immunodeficiency virus infection in Taiwan. This study investigated whether immune thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection in Taiwan. We conducted a retrospective population-based cohort study using data of individuals enrolled in Taiwan National Health Insurance Program. There were 5472 subjects aged 1–84 years with a new diagnosis of immune thrombocytopenic purpura as the purpura group since 1998–2010 and 21,887 sex-matched and age-matched, randomly selected subjects without immune thrombocytopenic purpura as the non-purpura group. The incidence of human immunodeficiency virus infection at the end of 2011 was measured in both groups. We used the multivariable Cox proportional hazards regression model to measure the hazard ratio and 95 % confidence interval (CI) for the association between immune thrombocytopenic purpura and human immunodeficiency virus infection. The overall incidence of human immunodeficiency virus infection was 6.47-fold higher in the purpura group than that in the non-purpura group (3.78 vs. 0.58 per 10,000 person-years, 95 % CI 5.83–7.18). After controlling for potential confounding factors, the adjusted HR of human immunodeficiency virus infection was 6.3 (95 % CI 2.58–15.4) for the purpura group, as compared with the non-purpura group. We conclude that individuals with immune thrombocytopenic purpura are 6.47-fold more likely to have human immunodeficiency virus infection than those without immune thrombocytopenic purpura. We suggest not all patients, but only those who have risk factors for human immunodeficiency virus infection should receive testing for undiagnosed human immunodeficiency virus infection when they develop immune thrombocytopenic purpura.

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References

  1. Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S (2008) Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost 99:4–13

    CAS  PubMed  Google Scholar 

  2. Palaniappan G, Jennings W (2009) Idiopathic thrombocytopenic purpura. Mo Med 106:69–73

    PubMed  Google Scholar 

  3. Provan D (2009) Characteristics of immune thrombocytopenic purpura: a guide for clinical practice. Eur J Haematol Suppl 71:8–12

    Article  Google Scholar 

  4. Watts RG (2004) Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clin Pediatr 43:691–702

    Article  Google Scholar 

  5. Zaki M, Hassanein AA, Khalil AF (1990) Childhood idiopathic thrombocytopenic purpura: report of 60 cases from Kuwait. J Trop Pediatr 36:10–13

    Article  CAS  PubMed  Google Scholar 

  6. Neylon AJ, Saunders PW, Howard MR, Proctor SJ, Taylor PR (2003) Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 122:966–974

    Article  PubMed  Google Scholar 

  7. Abrahamson PE, Hall SA, Feudjo-Tepie M, Mitrani-Gold FS, Logie J (2009) The incidence of idiopathic thrombocytopenic purpura among adults: a population-based study and literature review. Eur J Haematol 83:83–89

    Article  PubMed  Google Scholar 

  8. Fujimura K (2005) Helicobacter pylori infection and idiopathic thrombocytopenic purpura. Int J Hematol 81:113–118

    Article  PubMed  Google Scholar 

  9. Stasi R, Willis F, Shannon MS, Gordon-Smith EC (2009) Infectious causes of chronic immune thrombocytopenia. Hematol Oncol Clin N Am 23:1275–1297

    Article  Google Scholar 

  10. Franchini M, Vescovi PP, Garofano M, Veneri D (2012) Helicobacter pylori-associated idiopathic thrombocytopenic purpura: a narrative review. Semin Thromb Hemost 38:463–468

    Article  PubMed  Google Scholar 

  11. Pockros PJ, Duchini A, McMillan R, Nyberg LM, McHutchison J, Viernes E (2002) Immune thrombocytopenic purpura in patients with chronic hepatitis C virus infection. Am J Gastroenterol 97:2040–2045

    Article  PubMed  Google Scholar 

  12. Nakajima H, Takagi H, Yamazaki Y, Toyoda M, Takezawa J, Nagamine T et al (2005) Immune thrombocytopenic purpura in patients with hepatitis C virus infection. Hepatogastroenterology 52:1197–1200

    PubMed  Google Scholar 

  13. Karpatkin S, Nardi MA, Hymes KB (1988) Immunologic thrombocytopenic purpura after heterosexual transmission of human immunodeficiency virus (HIV). Ann Intern Med 109:190–193

    Article  CAS  PubMed  Google Scholar 

  14. Hollak CE, Kersten MJ, van der Lelie J, Lange JM (1990) Thrombocytopenic purpura as first manifestation of human immunodeficiency virus type I (HIV-1) infection. Neth J Med 37:63–68

    CAS  PubMed  Google Scholar 

  15. Bettaieb A, Fromont P, Louache F, Oksenhendler E, Vainchenker W, Duedari N et al (1992) Presence of cross-reactive antibody between human immunodeficiency virus (HIV) and platelet glycoproteins in HIV-related immune thrombocytopenic purpura. Blood 80:162–169

    CAS  PubMed  Google Scholar 

  16. Statistics of HIV/AIDS, Centers for Disease Control, Taiwan. http://www.cdc.gov.tw/english/index.aspx.  Accessed 1 Apr 2016

  17. Oksenhendler E, Seligmann M (1990) HIV-related thrombocytopenia. Immunodefic Rev 2:221–231

    CAS  PubMed  Google Scholar 

  18. Rigaud M, Leibovitz E, Quee CS, Kaul A, Nardi M, Pollack H et al (1992) Thrombocytopenia in children infected with human immunodeficiency virus: long-term follow-up and therapeutic considerations. J Acquir Immune Defic Syndr 5:450–455

    Article  CAS  PubMed  Google Scholar 

  19. Shah I (2013) Immune thrombocytopenic purpura: a presentation of HIV infection. J Int Assoc Provid AIDS Care 12:95–97

    Article  PubMed  Google Scholar 

  20. National Health Insurance Research Database, Taiwan. http://nhird.nhri.org.tw/en/index.html. Accessed 1 Apr 2016 (English version)

  21. Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC (2010) Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 89:295–299

    Article  Google Scholar 

  22. Hung SC, Liao KF, Lai SW, Li CI, Chen WC (2011) Risk factors associated with symptomatic cholelithiasis in Taiwan: a population-based study. BMC Gastroenterol 11:11–111

    Article  Google Scholar 

  23. Lai SW, Chen PC, Liao KF, Muo CH, Lin CC, Sung FC (2012) Risk of hepatocellular carcinoma in diabetic patients and risk reduction associated with anti-diabetic therapy: a population-based cohort study. Am J Gastroenterol 107:46–52

    Article  CAS  PubMed  Google Scholar 

  24. Chen HY, Lai SW, Muo CH, Chen PC, Wang IJ (2012) Ethambutol-induced optic neuropathy: a nationwide population-based study from Taiwan. Br J Ophthalmol 96:1368–1371

    Article  PubMed  Google Scholar 

  25. Cheng KC, Chen YL, Lai SW, Mou CH, Tsai PY, Sung FC (2012) Patients with chronic kidney disease are at an elevated risk of dementia: a population-based cohort study in Taiwan. BMC Nephrol 13:1471–2369

    Article  Google Scholar 

  26. Cheng KC, Chen YL, Lai SW, Tsai PY, Sung FC (2012) Risk of esophagus cancer in diabetes mellitus: a population-based case-control study in Taiwan. BMC Gastroenterol 12:12–177

    Article  Google Scholar 

  27. Chen YL, Cheng KC, Lai SW, Tsai IJ, Lin CC, Sung FC et al (2013) Diabetes and risk of subsequent gastric cancer: a population-based cohort study in Taiwan. Gastric Cancer 16:389–396

    Article  PubMed  Google Scholar 

  28. Kuo SC, Lai SW, Hung HC, Muo CH, Hung SC, Liu LL et al (2015) Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study. J Diabetes Complic 29:1071–1076

    Article  Google Scholar 

  29. Lai HC, Lin CC, Cheng KS, Kao JT, Chou JW, Peng CY et al (2014) Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study. Gastroenterology 146:129–137

    Article  PubMed  Google Scholar 

  30. Yang SP, Muo CH, Wang IK, Chang YJ, Lai SW, Lee CW et al (2015) Risk of type 2 diabetes mellitus in female breast cancer patients treated with morphine: a retrospective population-based time-dependent cohort study. Diabetes Res Clin Pract 110:285–290

    Article  CAS  PubMed  Google Scholar 

  31. Lai SW, Lin CL, Liao KF, Chen WC (2016) Herpes zoster could be an early manifestation of undiagnosed human immunodeficiency virus infection. J Formos Med Assoc 115:372–376

    Article  PubMed  Google Scholar 

  32. Elezovic I, Jevtovic D, Rolovic Z (1989) Immunologic thrombocytopenic purpura as a clinical manifestation of HIV infection. Srp Arh Celok Lek 117:499–506

    CAS  PubMed  Google Scholar 

  33. Zucker-Franklin D, Cao YZ (1989) Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA. Proc Natl Acad Sci USA 86:5595–5599

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ballem PJ, Belzberg A, Devine DV, Lyster D, Spruston B, Chambers H et al (1992) Kinetic studies of the mechanism of thrombocytopenia in patients with human immunodeficiency virus infection. N Engl J Med 327:1779–1784

    Article  CAS  PubMed  Google Scholar 

  35. Cole JL, Marzec UM, Gunthel CJ, Karpatkin S, Worford L, Sundell IB et al (1998) Ineffective platelet production in thrombocytopenic human immunodeficiency virus-infected patients. Blood 91:3239–3246

    CAS  PubMed  Google Scholar 

  36. Leissinger CA (2001) Platelet kinetics in immune thrombocytopenic purpura and human immunodeficiency virus thrombocytopenia. Curr Opin Hematol 8:299–305

    Article  CAS  PubMed  Google Scholar 

  37. Nardi MA, Liu LX, Karpatkin S (1997) GPIIIa-(49–66) is a major pathophysiologically relevant antigenic determinant for anti-platelet GPIIIa of HIV-1-related immunologic thrombocytopenia. Proc Natl Acad Sci USA 94:7589–7594

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Chia WK, Blanchette V, Mody M, Wright JF, Freedman J (1998) Characterization of HIV-1-specific antibodies and HIV-1-crossreactive antibodies to platelets in HIV-1-infected haemophiliac patients. Br J Haematol 103:1014–1022

    Article  CAS  PubMed  Google Scholar 

  39. Hsing AW, Ioannidis JP (2015) Nationwide population science: lessons from the Taiwan National Health Insurance Research Database. JAMA Intern Med 175:1527–1529

    Article  PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. College of Medicine, China Medical University, Taichung, Taiwan

      Shih-Wei Lai & Cheng-Li Lin

    2. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

      Shih-Wei Lai & Hsien-Feng Lin

    3. School of Chinese Medicine, China Medical University, Taichung, Taiwan

      Hsien-Feng Lin

    4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

      Cheng-Li Lin

    5. College of Medicine, Tzu Chi University, Hualien, Taiwan

      Kuan-Fu Liao

    6. Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan

      Kuan-Fu Liao

    7. Department of Internal Medicine, Taichung Tzu Chi General Hospital, No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung, 427, Taiwan

      Kuan-Fu Liao

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    1. Shih-Wei Lai
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    2. Hsien-Feng Lin
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    3. Cheng-Li Lin
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    Correspondence to Kuan-Fu Liao.

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    Funding

    This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019). This funding agency did not influence the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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    The authors declare that they have no conflict of interest.

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    This article does not contain any studies with human participants or animals performed by any of the authors.

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    S.-W. Lai and H.-F. Lin contributed equally to this study.

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    Lai, SW., Lin, HF., Lin, CL. et al. Immune thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection. Intern Emerg Med 12, 157–162 (2017). https://doi.org/10.1007/s11739-016-1520-9

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    • DOI: https://doi.org/10.1007/s11739-016-1520-9

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