Page 2547 - Hematology_ Basic Principles and Practice ( PDFDrive )

2270 Part XIII Consultative Hematology

TABLE Hematologic Toxicities of Antiretroviral Agents
157.3
Multiclass Combinations Protease Inhibitors:
Combination Brand Name Hematologic Toxicities Abbreviation Generic Name Brand Name Hematologic Toxicities
EFV+TDF+FTC Atripla Neutropenia, anemia APV amprenavir Agenerase
EFV+Rilpivirine+TDF Complera Neutropenia, anemia FOS-APV fosamprenavir Lexiva (US) Neutropenia
EFV+TDF+Elvitegravir+Cobicistat Stribild Neutropenia, anemia Telzir (Europe)
ATV atazanavir 7 Reyataz Neutropenia, anemia,
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors: thrombocytopenia.
Abbreviation Generic Name Brand Name Hematologic Toxicities DRV darunavir Prezista Anemia
3TC lamivudine Epivir Neutropenia, IDV indinavir Crixivan Neutropenia, anemia.
thrombocytopenia Thrombocytopenia
ABC abacavir Ziagen Thrombocytopenia. LPV/RTV lopinavir+ritonavir Kaletra Neutropenia, anemia,
AZT or ZDV zidovudine 1 Retrovir Pancytopenia, anemia, thrombocytopenia.
thrombocytopenia, Aluvia
neutropenia, pure red (developing
cell aplasia. world)
d4T stavudine 2 Zerit NFV nelfinavir Viracept Neutropenia, anemia,
lymphopenia.
ddI didanosine 3 Videx EC
RTV ritonavir Norvir Anemia
FTC emtricitabine Emtriva Neutropenia, anemia.
TDF tenofovir Viread Neutropenia. SQV saquinavir Invirase (hard
gel capsule)
Combined Nucleoside/Nucleotide Reverse Transcriptase Inhibitors: TPV tipranavir Aptivus Neutropenia, anemia.
Combination Brand Name Hematologic Fusion or Entry Inhibitors:
Toxicities Abbreviation Generic Name Brand Name Hematologic Toxicities
ABC+3TC Epzicom (US) Neutropenia, anemia, T-20 enfuvirtide Fuzeon Neutropenia, anemia,
Kivexa (Europe) thrombocytopenia eosinophilia
ABC+AZT+3TC Trizivir 4 Neutropenia, anemia, MVC maraviroc Celsentri
thrombocytopenia. (Europe)
AZT+3TC Combivir Neutropenia, anemia, Selzentry (US) Neutropenia
thrombocytopenia.
Integrase Inhibitors:
TDF+FTC Truvada Neutropenia, anemia.
Abbreviation Generic Name Brand Name Hematologic Toxicities
Nonnucleoside Reverse Transcriptase Inhibitors: RAL raltegravir Isentress Anemia,
Abbreviation Generic Name Brand Name Hematologic Toxicities thrombocytopenia.
DLV delavirdine 5 Rescriptor Anemia dolutegravir Tivicay
elvitegravir Viteka
EFV efavirenz Sustiva (US) Neutropenia
Stocrin (Europe)
ETR etravirine 6 Intelence
NVP nevirapine Viramune Neutropenia
relpivirine Edurant

initial therapy, monthly maintenance therapy with 0.4 g/kg IVIg may advanced HIV infection is decreased serum B 12 levels. Low serum B 12
be required. Immune reconstitution resulting from the successful use has been documented in approximately one-third of patients with
of HAART may lead to complete remission of this condition. 17 AIDS. Patients with advanced HIV infection (AIDS) appear to
acquire gastrointestinal defects resulting in B 12 malabsorption. The
Anemia Resulting From Ineffective Red Blood mechanisms responsible for decreased B 12 absorption observed in
these patients include both infections of and other acquired disorders
Cell Production of the small intestine and ileum, food B 12 malabsorption secondary
to inadequate gastric acid production, and true pernicious anemia
+
+
Ineffective production of red cells can occur with deficiencies of folate with antibodies to the H /K parietal cell pump and intrinsic factor.
or vitamin B 12. Ineffective production of RBCs is frequently charac- However, not all cases of low serum levels of B 12 are associated with
terized by concomitant decreases in platelets and neutrophils true metabolic B 12 deficiency as characterized by elevated methylma-
accompanied by megaloblastic red cell morphology with large oval lonic acid. This may result from the finding that some patients with
macrocytes and hypersegmented neutrophils. In addition to a low neutropenia secondary to a hypocellular bone marrow may have low
reticulocyte count there may be elevations in indirect bilirubin and serum levels of transcobalamin (TC) I, the major serum B 12 carrier
serum lactate dehydrogenase. Because of the relatively small tissue protein, which is found in the specific granules of neutrophils.
stores of folate, patients with advanced HIV disease who have poor However, transport of B 12 into cells is mediated by TC II, which
dietary intake, excessive alcohol ingestion, and/or jejunal disease may carries only 25% to 30% of serum B 12, and for that reason the newer
become deficient in folate. More commonly reported in patients with assays that measure B 12 bound to TC II (holotranscobalamin II