Oxymetholone Improves Aplastic Anemia with an Underlying HIV Infection: A Case Report

Abstract

Abstract: Oxymetholone is a semi-synthetic androgen and it is found effective in idiopathic aplastic anemia but its therapeutic effect in case of severe aplastic anemia associated with HIV infection has been rarely reported. Herein, we report a 46-year-old Thai man who was newly diagnosed as having aplastic anemia based on the combination of pancytopenia without peripheral blast and the aplasia of the bone marrow from biopsy, concomitantly withan HIV infection. The CD4 count was 437/mm³ whereas the viral titer was 57,720. Oxymetholonetherapy 150 mg. a day was initiated while the HAART was withheld because of CD4 >350/mm³. Other regular treatments included deferiprone 1,500 mg. a day for hyperferritinemia, quinine sulfate 300 mg. before bed time for the night cramp. He regularly attended our clinic every month. The packed red blood cells would be transfused to him if his Hb concentration was less than 7.0 g%. The hematologic parameters were gradually increased every year. Within four years, Hb, WBC and platelet were increased from 6.6 g%, 2,500/mm³, 10,000/mm³ to be 13.2 g%, 4,000/mm³, 30,000/mm³, respectively while the CD4 count was increased from 437 to finally 526/mm³, instead of decrease even lack of HAART. No serious adverse effect of oxymetholone was observed. Pancytopeniaas well as CD4 count in our case was markedly improved after the treatment with oxymetholone possibly due to its stimulating effect upon the proliferation of the hematopoietic stem cells within the bone marrow.