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
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
Palaniappan G, Jennings W (2009) Idiopathic thrombocytopenic purpura. Mo Med 106:69–73
Provan D (2009) Characteristics of immune thrombocytopenic purpura: a guide for clinical practice. Eur J Haematol Suppl 71:8–12
Watts RG (2004) Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clin Pediatr 43:691–702
Zaki M, Hassanein AA, Khalil AF (1990) Childhood idiopathic thrombocytopenic purpura: report of 60 cases from Kuwait. J Trop Pediatr 36:10–13
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
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
Fujimura K (2005) Helicobacter pylori infection and idiopathic thrombocytopenic purpura. Int J Hematol 81:113–118
Stasi R, Willis F, Shannon MS, Gordon-Smith EC (2009) Infectious causes of chronic immune thrombocytopenia. Hematol Oncol Clin N Am 23:1275–1297
Franchini M, Vescovi PP, Garofano M, Veneri D (2012) Helicobacter pylori-associated idiopathic thrombocytopenic purpura: a narrative review. Semin Thromb Hemost 38:463–468
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
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
Karpatkin S, Nardi MA, Hymes KB (1988) Immunologic thrombocytopenic purpura after heterosexual transmission of human immunodeficiency virus (HIV). Ann Intern Med 109:190–193
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
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
Statistics of HIV/AIDS, Centers for Disease Control, Taiwan. http://www.cdc.gov.tw/english/index.aspx. Accessed 1 Apr 2016
Oksenhendler E, Seligmann M (1990) HIV-related thrombocytopenia. Immunodefic Rev 2:221–231
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
Shah I (2013) Immune thrombocytopenic purpura: a presentation of HIV infection. J Int Assoc Provid AIDS Care 12:95–97
National Health Insurance Research Database, Taiwan. http://nhird.nhri.org.tw/en/index.html. Accessed 1 Apr 2016 (English version)
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
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
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
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
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
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
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
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
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
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
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
Elezovic I, Jevtovic D, Rolovic Z (1989) Immunologic thrombocytopenic purpura as a clinical manifestation of HIV infection. Srp Arh Celok Lek 117:499–506
Zucker-Franklin D, Cao YZ (1989) Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA. Proc Natl Acad Sci USA 86:5595–5599
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
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
Leissinger CA (2001) Platelet kinetics in immune thrombocytopenic purpura and human immunodeficiency virus thrombocytopenia. Curr Opin Hematol 8:299–305
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
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
Hsing AW, Ioannidis JP (2015) Nationwide population science: lessons from the Taiwan National Health Insurance Research Database. JAMA Intern Med 175:1527–1529
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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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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