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Persistent B19 Parvovirus Infection in Patients Infected with Human Immunodeficiency Virus Type 1 (HIV-1): A Treatable Cause of Anemia in AIDS
- Norbert Frickhofen, MD;
- Janis L. Abkowitz, MD;
- Monika Safford, MD;
- J. Michael Berry, MD;
- Jorge Antunez-de-Mayolo, MD;
- Alan Astrow, MD;
- Robert Cohen, MD;
- Ira Halperin, MD;
- Lambert King, MD, PhD;
- David Mintzer, MD;
- Bernard Cohen, MD; and
- Neal S. Young, MD
Abstract
Objective: To determine the role of B19 parvovirus in red cell aplasia of patients infected with human immunodeficiency virus type 1 (HIV-1).
Design: Uncontrolled clinical trial, with assay of serum, peripheral blood cells, and bone marrow for virus using DNA hybridization and immunocytochemistry techniques; these assays were then correlated with clinical findings, results of immunoassays for antivirus antibodies, and with immunoglobulin (Ig) therapy.
Setting: Government medical referral center, and university and private hospitals.
Patients: Seven patients with pure red cell aplasia and serologic evidence of infection with HIV-1.
Measurements and Main Results: All patients had giant pronormoblasts in the bone marrow (present in transient aplastic crisis caused by acute B19 parvovirus infection). High concentrations of B19 parvovirus were demonstrated in sera, in several cases in samples separated by weeks or months. Viral DNA and capsid protein were present in the bone marrow of three patients studied, and active viral replication was detected by southern analysis. There was no antivirus IgG in capture immunoassay and no or very low levels of antivirus IgM. The patients did not have symptoms of fifth disease, the illness caused by this virus in immunologically normal persons. Six patients were treated with a regimen of intravenous commercial immunoglobulin. In all cases, this therapy resulted in rapid reduction in serum virus concentrations and full recovery of erythropoiesis. Relapses in two cases were predicted by DNA hybridization studies, and these cases were successfully retreated.
Conclusions: The B19 parvovirus is a remediable cause of severe chronic anemia in HIV-infected patients. Recognition of and therapy for parvovirus in this population will avoid erythrocyte transfusion and should prevent transmission of the virus to other persons, including immunosuppressed persons and women of child-bearing age.
Article and Author Information
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From the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the University of Washington School of Medicine, Seattle, Washington; Miriam Hospital, Brown University, Providence, Rhode Island; Pacific Presbyterian Medical Center, San Francisco, California; University of Miami School of Medicine, Miami, Florida; St. Vincent's Hospital and Medical Center, New York, New York; Pennsylvania Hospital, Philadelphia, Pennsylvania; and the Central Public Health Laboratory, Collingdale, London, United Kingdom. For current author addresses, see end of text.
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Requests for Reprints: Neal S. Young, MD, National Heart, Lung, and Blood Institute, Building 10/7C103, 9000 Rockville Pike, Bethesda, MD 20892.
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Current Author Addresses: Dr. Frickhofen: Department of Internal Medicine III, University of Ulm, Ulm, West Germany.
Dr. Abkowitz: Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195.
Dr. Safford: Miriam Hospital, Brown University, Providence, RI 02909.
Dr. Berry: Pacific Presbyterian Medical Center, San Francisco, CA 94115.
Drs. Antunez-de-Mayolo and Young: Cell Biology Section, Clinical Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
Drs. Astrow, Cohen, Halperin, and King: Department of Medicine, St. Vincent's Hospital and Medical Center, New York, NY 10011.
Dr. Mintzer: Pennsylvania Hospital, Philadelphia, PA 19105.
Dr. Cohen: Central Public Health Laboratory, Collindale, London, UK.
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