Improvementof Aplastic Anemia and HIV Infectionafter Oxymetholone Therapy: A Case Report

Abstract

Aplastic anemia is a hematopoietic stem cell defect possibly due to an autoimmune process. It is characterized by the combination of the peripheral pancytopenia and hypocellular marrow. Besideshorse antithymocyte globulinwith cyclosporine orstem cell transplantation, oxymetholone, the synthetic androgen, is also allowed to be the alternative treatment for the patients who had non-severe aplastic anemiaor could not access the sophisticated therapies. And herein, therole as the treatment of aplastic anemia complicated bythe human immunodeficiency virus (HIV) infection of oxymetholonewill be reported. He was a 40-year old Thai man who presented with pancytopenia, Hb 4.7 g%, WBC 2,650/mm³, platelet 5,000/mm³, N 23 %, L 62 %, and diffuse medullary aplasia in the bone marrow, no evidence of HIV infection. He was treated with oxymetholone 150 mg a day and the regular blood transfusion every 1-3 months for keeping his Hb level 7 g% or more. Two years later, HIV antigen/antibody wasfound positive. The CD4 count was 437/mm³ or 31 %, andanti-retroviral therapy was neverinitiated. Every year, hematologic parameters as well as CD4 count were gradually increased during long term oxymetholone therapy without the drug side effect or any opportunistic infection until transfusion was finally not necessary althoughthe viral load had never beenstudied through the long follow-up period. The present hematologic parameters were: Hb 13.0 g%, WBC 5,300/mm³, platelet 24,000/mm³, and CD4 526/ mm³. Both AA and the CD4 count in our case seemed to slowly respond to oxymetholone therapy without the anti-retroviral regimen.