Hematologic manifestations of HIV infection: Neutropenia
- Timothy J Friel, MD
Timothy J Friel, MD
- Associate Clinical Professor of Medicine
- University of South Florida Morsani College of Medicine
- David T Scadden, MD
David T Scadden, MD
- Professor of Medicine
- Harvard Medical School
Shortly after the first description of the acquired immunodeficiency syndrome (AIDS), cytopenias of all major blood cell lines were increasingly recognized in patients with human immunodeficiency virus (HIV) infection. As an example, in one early series of patients with AIDS, anemia was noted in approximately 70 percent, lymphopenia in 70 percent, neutropenia in 50 percent, and thrombocytopenia in 40 percent .
The incidence of the various cytopenias correlates directly with the degree of immunosuppression. As an example, the incidence of neutropenia varies from 5 to 10 percent in the early, asymptomatic stages of infection to as high as 50 to 70 percent of patients with advanced disease. The degree of neutropenia may be overestimated from the total white blood cell count due to the associated lymphopenia (as evidenced by the low CD4 cell count).
However, isolated abnormalities, including neutropenia, may be encountered as the initial presentation of HIV infection. As a result, HIV infection should be considered in the assessment of patients presenting with any type of cytopenia. In fact, in one large series of more than 370,000 Danish patients, baseline neutropenia was identified in approximately 1 percent of all patients; during four years of follow-up, the presence of neutropenia had a stronger association with the incident diagnosis of HIV than any other viral infection .
This topic review will discuss the causes, clinical impact, and treatment of neutropenia in patients with HIV infection. HIV-associated anemia, thrombocytopenia, coagulation defects, and lymphopenia are discussed separately. (See "Hematologic manifestations of HIV infection: Anemia" and "Hematologic manifestations of HIV infection: Thrombocytopenia and coagulation abnormalities" and "Techniques and interpretation of measurement of the CD4 cell count in HIV-infected patients".)
Neutropenia is defined as an absolute neutrophil count (ANC) of less than 1500/microL. The ANC is equal to the product of the white blood cell count (WBC) and the fraction of polymorphonuclear cells (PMNs) and band forms noted on the differential analysis:
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- IMPACT OF NEUTROPENIA IN PATIENTS WITH HIV
- INITIAL APPROACH TO THE MANAGEMENT OF HIV-INFECTED PATIENTS WITH NEUTROPENIA
- USE OF COLONY STIMULATING FACTORS (G-CSF OR GM-CSF)
- Overview of available products
- Treatment with G-CSF
- - Effect on neutrophil function
- - Effect on CD4 cells
- - G-CSF side effects
- - Dose
- Treatment with GM-CSF
- - Possible stimulation of HIV replication
- - Other GM-CSF side effects
- SUMMARY AND RECOMMENDATIONS