Background Human immunodeficiency virus (HIV) is associated with numerous hematological disorders—anemia, pancytopenia, and hemostatic abnormalities being the most common ones. Direct antiglobulin test has frequently been observed in the clinical syndrome of HIV, but autoimmune hemolytic syndrome (AIHA) is rare. Review of other reports of DAT and AIHA in patients with HIV infections suggests that these autoantibodies may be associated with anemia in this population. Many of these patients are also concurrently infected with hepatitis C virus (HCV). We recently reported a significantly higher incidence of autoantibodies to red blood cells in patients with HCV infection as compared to healthy blood donors. We also noted an even higher incidence of autoantibodies to red blood cells in patients concurrently positive for both HCV and HIV. We hypothesized that HCV infection in patients with HIV confers a much higher risk of developing autoantibodies against red blood cells.
Method Sixty-eight patients with HCV and HIV were randomly screened for DAT and AIHA in our hospital from June 2001 to June 2004.
Results Thirty-four patients were positive for HIV. Among them 16 were positive for HCV and 18 were negative. Thirty-four patients were positive for HCV only.
We noted an incidence of 18.8% of DAT positivity in patients with concurrent HIV and HCV infection. One of these three patients had clinical AIHA, with high LDH, indirect bilirubinemia, and low haptoglobin. Five percent of the patients with HIV in the absence of HCV had positive DAT. There was no clinical AIHA in this group, and 14.7% of patients with HCV infection alone had positive DAT. One of these five patients had clinical AIHA.
Conclusion Our study indicates that HIV-positive patients who are concurrently infected with HCV have a higher incidence of autoantibodies against erythrocytes.