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Acta Médica Costarricense

On-line version ISSN 0001-6002Print version ISSN 0001-6012


NOGUERA-VALVERDE, Ronald A  and  BOZA-CORDERO, Ricardo. Chronic neutropenia and human immunodeficiency virus infection. Acta méd. costarric [online]. 2008, vol.50, n.3, pp.175-177. ISSN 0001-6002.

A case of a male with chronic neutropenia and human immunodeficiency virus infection is presented along, with a review of possible pathogenic mechanisms. Hematological abnormalities as anemia, thrombocytopenia and leucopenia are frequently associated with acute human immunodeficiency virus infection. As antiretroviral therapy establishes and viral activity diminishes, hematological disturbances improve. However, some antiretroviral drugs, e.g., zidovudine, exhibits medullary toxicity and it can worsen the hematological findings in these patients, forcing subsequent changes on therapeutic schemes. Cytotoxics used in associated neoplasms have known antimedullary activity. Some antimicrobial agents like trimethoprimsulfamethoxazole, used prophylactically, also exhibit medullary toxicity, because of this, they should be used with caution or should be avoided. Finally, other mechanisms which can cause neutropenia are enlisted: formation of anti- neutrophiles antibodies, primary damage of granulocyte progenitor, imbalance of neutrophil production, antibodies against gp120 viral envelope glycoprotein, or vitamins deficiencies. The approach of the neutropenic febrile patient in whom severe bacterial infection is suspected, includes the use of granulocyte-colonies stimulating factors in order to increase the absolute neutrophil count and to achieve a better clinical outcome.

Keywords : Chronic neutropenia; high activity antiretroviral therapy; HIV infection; granulocyte-colony stimulant factors; adverse effects.

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