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1 ,** The Japanese Society for AIDS Research The Journal of AIDS Research HIV HIV + : HIV HIV-TP HIV HIV HIV-TP + :.. + A,2 HIVHCV -* CD. ddi -., / ml, HIV-RNA +**.** copyml.+ HIV-RNA ++*** copiesml *** ml HIV-TP PSL -TC HIV-RNA PSL +* ml + HIV-RNA -*** ml PSL PSL HIV ddi, -TC HIV AZTTDFFTCrATV PSL.* ml :, HIV-TP HIV-RNA HIV HIV-TP :HIV ++ :,-2,.,,** ++*** copiesml -TC PSL HIV HIV +* ml HIV-RNA HIV,**0 -,**1, HCV PEG- IFNa, a HCV-RNA, HIV-RNA HCV-RNA,**1. HIV-RNA 11 copiesml + 1 / PAIgG PAIgG +++* ng+* cells Plt,/. ml HIV-TP + A,2 HIVHCV -* CD. ddi -., / ml, HIV- RNA +**.** copiesml HIV HIV-TP.+ *** ml HIV +., ml + PSL0* mg Plt -*** ml PSL 0* mg + a HIV-RNA + b HIV ddi, : *0* / - TC,,**. ;,** 1,2 AZTTDFFTCrATV,-2 02

2 The Journal of AIDS Research Vol. ++ No. -,** + a + WBC 2-** / ml TP 042 g/dl PT +,4* sec CD. /,. / ml Alb.4, g/dl APTT./4* sec RBC..0, +* / ml AST.. IU/l Fib,+. mg/dl Hb +/4, g/dl ALT 1+ IU/l FDP,40 mg/ml Hct..4* LDH -*/ IU/l MCV /4- fl T-Bil +40 mg/dl MCH -,42 pg D-Bil *4, mg/dl Helicobacter pylori MCHC -.4/ ALP.+ IU/l Plt. +4, +* / ml g-gtp,+ IU/l HBsAb 2,40 miu/ml Na +.* meq/l HBsAg K -41 meq/l HBcAb 041 Cl +*, meq/l HCV-RNA +0**** copies/ml BUN +- mg/dl HIV-RNA -//* copies/ml Cre *41 mg/dl UA /4. mg/dl CRP *4+ mg/dl HbA+ c 140 +* ml f+,. + cm PSL.* ml PSL HIV-TP.* ml PSL -* mg HIV-TP,- 0

3 M Onozawa et al : Recurrence of HIV-related Thrombocytopenia Accompanied by Emergence of a Drug-resistant Virus + b, HIV NRTI resistance mutations : M.+ L, L1. V, M+2. I PI major resistance mutations : None NNRTI resistance mutations : None PI minor resistance mutations : None Other mutations : R2- K, D+,- E, I+-/ T, S+0, H, Other mutations : I+/ V, M-0I I+/ M, G+0 E, A,1, S ATV Susceptible NRTI DRV Susceptible -TC High-level resistance FPV Susceptible ABC Intermediate resistance IDV Susceptible AZT Susceptible LPV Susceptible D. T Potential low-level resistance NFV Susceptible DDI High-level resistance SQV Susceptible FTC High-level resistance TPV Susceptible TDF Susceptible NNRTI DLV Susceptible EFV Susceptible NVP Susceptible : International AIDS society-usa Drug Registance Mutations Group Panel (August/September,**0) ITP HIV HIV-related thrombocytopenia : CD., CXCR. HIV-TP HIV HIV HIV + /-* HIV,.* 1*

4 The Journal of AIDS Research Vol. ++ No. -,**, AZT HIV HIV, HIV-RNA PSL HIV HIV-RNA -., HIV PSL HAART HIV-TP PSL / CD. HIV / Aboulafia HAART 0 + HIV HIV-TP HIV + Liebman HA : Viral-associated immune thrombocytopenic purpura. Hematology Am Soc Hematol Educ Pro- HIV-TP gram,**2 :,+,,+2,,**2. HIV gp+,* gp+0* IIbIIIa, Kowalska MA, Ratajczak J, Hoxie J, Brass LF, Gewirtz 1 + HIV-TP ITP -,1 : , +,. 2, 2 +* H. pylori + +. Najean Y, Rain JD : The mechanism of thrombocytopenia in patients with HIV infection. J Lab Clin Med HIV / Arranz Caso JA, Sanchez Mingo C, Garcia Tena J : HIV-TP H. pylori 0 Aboulafia DM, Bundow D, Waide S, Bennet C, Kerr D : AIDS +,- :.+/.,*, +.. Med -.+ : +,- +,.*, +. A, Poncz M, Ratajczak MZ : Megakaryocytes precursers., HIV-TP Megakaryocytes and platelets express the HIV co-receptor HIV-RNA HIV-RNA CXCR. on their surface : determination of response to stromal-derived factor-+ by megakaryocytes and platelets. Br J Haematol +*. :,,*,,, +. HIV-TP - Ballem PJ, Belzberg A, Devine DV, Lyster D, Spruston /* B, Chambers H, Doubro# P, Mikulash K : Kinetic studies / ml of the mechanism of thrombocytopenia in patients with human immunodeficiency virus infection. N Engl J Med H. pylori E# ect of highly active antiretroviral therapy on thrombocytopenia in patients with HIV infection. N Engl J HCV Initial observation on the e$ cacy of highly active antiretroviral therapy in the treatment of HIV-associated HCV-RNA autoimmune thrombocytopenia. Am J Med Sci -,* : ++1 HCV 1 +,-,,***. Bettaieb A, Fromont P, Louache F, Oksenhendler E, HIV Vainchenker W, Duedari ÿ N, Bierling P : Presence of cross-reactive antibody between human immunodeficiency virus (HIV) and platelet glycoproteins in HIV- HIV-RNA HIV-TP related immune thrombocytopenic purpura. Blood 2* : HAART HIV-RNA +0, +0, +,. HIV-TP 2 Oksenhendler E, Bierling P, Chevret S, Delfraissy JF, Laurian Y, Clauvel JP, Seligmann M : Splenectomy is safe and e# ective in human immunodeficiency virus-related HIV HIV + immune thrombocytopenia. Blood 2, :,-,, +-.,.+ 1+

5 M Onozawa et al : Recurrence of HIV-related Thrombocytopenia Accompanied by Emergence of a Drug-resistant Virus Lord RV, Coleman MJ, Milliken ST : Splenectomy for HIV-related immune thrombocytopenia : comparison with Yonezumi M, Chiba K, Kondo T, Ota S, Toyashima N, Kato N, Tanaka J, Imamura M, Asaka M : Platelet reresults of splenectomy for non-hiv immune thrombo- covery in patients with idiopathic thrombocytopenic purcytopenic purpura. Arch Surg +-- :,*/,+*, +2. pura after eradication of Helicobacter pylori. Int J Hematol +* Hashino S, Mori A, Suzuki S, Izumiyama K, Kahata K, 11 : ,,**-. Recurrence of HIV-related Thrombocytopenia Accompanied by Emergence of a Drug-resistant Virus Masahiro O NOZAWA, Satoshi H ASHINO, Kohei O KADA, Rena M ORITA, Mutsumi T AKAHATA, Akio S HIGEMATSU, Kaoru K AHATA, Takeshi K ONDO, Masahiro ASAKA and Masahiro IMAMURA Stem Cell Transplantation Center, Hokkaido University Hospital Objective : HIV-related thrombocytopenia (HIV-TP) is a well-known complication in HIV patients. We report a case of HIV-TP that was exacerbated following the transient increase of HIV-RNA. Case Report : A..-year-old male was admitted to our hospital due to thrombocytopenia. He was diagnosed with hemophilia A at the age of + year, and HIV and HCV infections were diagnosed when he was,2 years old. At the age of -* years, he was prescribed ddi due to a progressive decrease in CD. count. He was followed in our hospital from the age of -. years, and thereafter his platelet count and HIV-RNA were around,* /* +* /L and +**.** copies/ml, respectively. When he was.+ years old, his platelet count dropped to +* /L after a transient increase in HIV-RNA ( ++*** copies/ml). HIV-TP was diagnosed and was successfully treated with prednisolone. After addition of -TC, HIV-RNA decreased to an undetectable level. Platelet count remained around +** +* /L after cessation of prednisolone administration. One month before admission, a transient increase in HIV-RNA was observed and then platelet number decreased. His platelet count decreased to - +* /L after admission, and treatment with prednisolone was started. An immediate response to prednisolone treatment was observed. Since a drug resistance study revealed HIV highly resistant to both ddi and -TC, antiviral therapy was changed to AZTTDF/FTCrATV. Due to complication of diabetes and psychiatric side e# ects of steroids, as well as concern about recurrence of thrombocytopenia, he underwent splenectomy. After splenectomy, the platelet count increased to.** +* /L. Conclusion : Our case was unique in that an increase in HIV-RNA was preceded by two episodes of thrombocytopenia. The transient increase of HIV-RNA might have triggered the recurrence of HIV-TP in our case. Key words : HIV-associated thrombocytopenia, idiopathic thrombocytopenic purpura, splenectomy, drug-resistant,., 1,