Nasal bleeding in HIV-infected patients

Close metadata

OBJECTIVE

To analyze and identify the true causes of recurrent diapedesis nasal bleeding in HIV-infected patients.

PATIENTS AND METHODS

The data from 25 patients with HIV infection and nasal bleeding (NB) were analyzed; 11 (44%) patients received antiretroviral therapy (ART). The average follow-up in the HIV center was 6.7±6.1 years.

RESULTS

The decrease of platelets count to 53.4±53.24 was revealed in 20 (80%) patients; decreased CD4 <200 cells/μl in 6 (24%) patients, CD4 200—500 cells/μl in 11 (44%) patients, CD4 >500 cells/μl in 8 (32%) patients; 17 (68%) patients had an average viral load of 683.180±362.899 copies in 1 ml of plasma. All patients were diagnosed with HIV-associated conditions; the most common were the following: HIV-associated immune thrombocytopenia (64%), moderate to severe anemia (16%), CMV infection (pneumonitis, esophagitis, colitis) (28%), active CMV infection with multi-organ involvement (28%), fungal infection of nasopharyngeal area (12%). Patients received pathogenetic and supportive therapy. All previously untreated patients were prescribed ART, and in those receiving treatment, ART was adjusted. Drug therapy resulted in the normalization of hematological parameters and stopped nasal bleeding.

CONCLUSION

Recurrent nasal bleeding in patients with HIV infection is relatively common and is a consequence of HIV-associated hemostasis disorders, which should be considered when choosing treatment. On the other hand, patients with recurrent nasal bleeding require comprehensive evaluation to clarify the possible causes of such hemorrhages, including the HIV infection.

Keywords:

AIDS

HIV

HIV infection

nasal bleeding

thrombocytopenia

Authors:

Kryukov A.I.

Sverzhevsky Research Clinical Institute of Otorhinolaryngology;
Pirogov Russian National Research Medical University

ORCID: 0000-0002-0149-0676

Bessarab T.P.

Sverzhevskiy Research Clinical Institute of Otorhinolaryngology

Tovmasyan A.S.

Sverzhevsky Research Clinical Institute of Otorhinolaryngology

ORCID: 0000-0002-1214-4939

Bavin K.S.

L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology

Received:

01.10.2021

Accepted:

15.10.2021

List of references:

Filippov PG, Timchenko OL, Ogiyenko OL, Mikhneva SA, Popova TI, Sergeyeva TV, Sosedova MA. Ostraya VICH-infektsiya: problemy ranney diagnostiki (klinicheskoye nablyudeniye). Infektsionnyye bolezni: Novosti. Mneniya. Obucheniye. 2017;5:22. (In Russ.).
Volkov AG, Boyko NV, Kiselev VV. Nosovyye krovotecheniya. M.: APP «Dzhangar»; 2002. (In Russ.).
Pal’chun VT, Kunel’skaya NL, Kislova NM. Ekstrennaya patologiya nosa i okolonosovykh pazukh. Vestnik otorinolaringologii. 1998;3:4-12. (In Russ.).
Gadzhimirzayev GA, Tulkin VN, Gadzhimirzayeva RG. Nosovyye krovotecheniya. Analiticheskiy obzor i sobstvennyy opyt. Rossiyskaya otorinolaringologiya. 2014;5:72. (In Russ.).
Prasad H, Bhojwani K, Shenoy V, Prasad S. HIV manifestations in otolaryngology. American Journal of Otolaryngology. 2006;27(3):179-185. https://doi.org/10.1016/j.amjoto.2005.09.011
Bakhshaee M, Sarvghad M, Khazaeni K, Movahed R, Hoseinpour A. HIV: An epidemiologic study on head and neck involvement in 50 patients. Iranian Journal of Otorhinolaryngology. 2014;26(75):97-104.
Hoffmann C, Rockstroh JK. HIV 2012/2013. Hamburg: Medizin Fokus; 2014. (In Russ.).
George J, Woolf S, Raskob G, Wasser J, Aledort L, Ballem P, Blanchette V, Bussel J, Cines D, Kelton J, Lichtin A, McMillan R, Okerbloom J, Regan D, Warrier I. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88(1):3-40.
Soliev KK, Abduvahobova NR, Soliev DK, Ahmedova HYu. Neotlozhnaya pomoshch’ pri massivnom krovotechenii u bol’nyh ideopaticheskoj trombocitopenicheskoj purpuroj. Vestnik ekstrennoj mediciny. 2013;3:234-240. (In Russ.).
Shamsinov BN, Mukhtorova PR, Olimov TKh, Akhrorova ZA. Etiologicheskiye aspekty nosovykh krovotecheniy i al’ternativnyye sposoby ikh ostanovki. Vestnik Avitsenny. 2020;1:28-32. (In Russ.).
Durandt C, Potgieter JC, Mellet J, Herd C, Khoosal R, Nel JG, Rossouw T, Pepper MS. HIV and haematopoiesis. South African Medical Journal. 2019;109(8b):40-45. https://doi.org/10.7196/SAMJ.2019.v109i8b.13829
Schwartz G, Kessler S, Szabo J, Burrell L, Francis M. Negative regulators may mediate some of the inhibitory effects of HIV-1 infected stromal cell layers on erythropoiesis and myelopoiesis in human bone marrow long term cultures. Journal of Leukocyte Biology. 1995;57(6):948-955. https://doi.org/10.1002/jlb.57.6.948
Gibellini D, Clò A, Morini S, Miserocchi A, Ponti C, Re M. Effects of human immunodeficiency virus on the erythrocyte and megakaryocyte lineages. World Journal of Virology. 2013;2(2):91-101. https://doi.org/10.5501/wjv.v2.i2.91
MacEneaney O, Connick E, DeSouza C. Effects of HIV-1 gp120 and protease inhibitors on apoptotic susceptibility of CD34+ hematopoietic progenitor cells. JAIDS: Journal of Acquired Immune Deficiency Syndromes. 2011;56(2):e49-50. https://doi.org/10.1097/QAI.0b013e3181fb1cb3
Zucker-Franklin D, Cao Y. Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA. Proceedings of the National Academy of Sciences of the United States of America. 1989;86(14):5595-5599. https://doi.org/10.1073/pnas.86.14.5595
Nardi M, Tomlinson S, Greco M, Karpatkin S. Complement-independent, peroxide-induced antibody lysis of platelets in HIV-1-related immune thrombocytopenia. Cell. 2001;106(5):551-561. https://doi.org/10.1016/s0092-8674(01)00477-9
Zinovkina VYu, Vismont FI, Kasap VA. Narusheniya gemostaza. Metodicheskiye rekomendatsii. Minsk: MGMI; 2000. (In Russ.).
Hart D, Sayer R, Miller R, Edwards S, Kelly A, Baglin T, Hunt B, Benjamin S, Patel R, Machin S, Scully M. Human immunodeficiency virus associated thrombotic thrombocytopenic purpura-favourable outcome with plasma exchange and prompt initiation of highly active antiretroviral therapy. British Journal of Haematology. 2011;153(4):515-519. https://doi.org/10.1111/j.1365-2141.2011.08636.x
Puzyreva L., Safonov A. Investigation of thrombocytopenia in the HIV-infected. Vrach. 2017; 4: 25-27. (In Russ).
Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen B, Ganz T. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. Journal of Clinical Investigation. 2004;113(9):1271-1276. https://doi.org/10.1172/JCI20945
Gorynya LA, Mazurov VI, Musatov VB. Anemiya u VICH-infitsirovannykh patsiyentov. Patogenez i sovremennaya terapevticheskaya taktika. Vestnik Sankt-Peterburgskogo universiteta. Meditsina. 2014;2:54-66. (In Russ.).
Abbas F, Refaat L, Hussien A, El-Shazly A. Hepatitis C virus induces nasal epithelial erosion and sub-epithelial rhinitis. Rhinology. 2009;47(4):438-443. https://doi.org/10.4193/Rhin08.120
Mestnikova AZ, Artyushkin SA, Stel’makh VV. Patogeneticheskiye mekhanizmy razvitiya nosovogo krovotecheniya pri khronicheskom virusnom gepatite S. Rossiyskaya otorinolaringologiya. 2016;1(80):67-71. (In Russ.).
Khasanova GR. Anemiya khronicheskogo zabolevaniya i VICH-infektsiya. Prakticheskaya medicina. 2012;1(56):49-51. (In Russ.).

Close metadata