Recovery of Aplastic Anemia Complicated by HIV Infection after 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 peripheral pancytopenia and the hypocellular bone marrow. Besides the horse antithymocyte globulin with cyclosporine or the stem cell transplantation, oxymetholone, the synthetic androgen, is also allowed to be the alternative treatment for non-severe aplastic anemia. And herein, the role of oxy-metholoneas the treatment of aplastic anemia complicated by the human immunodeficiency virus (HIV) infection is reported. The patient was a 40-year-old Thai vendor who presented with the pancytopenia, Hb 7.1 g%, WBC 2,700/mm³, platelet 7,000/mm³, N 23 %, L 62 %, reticulocyte 0.8 %and diffuse medullary aplasia in the bone marrow. He was diagnosed as aplastic anemia and treated with oxymetholone 150 mg a day and on demand blood transfusion if Hb concentration less than 7.0 g%. Two years later, HIV antigen/antibody was tested and found positive. The CD4 count was 437/mm³ or 31 % and the anti-retroviral therapy was not initiated. Every year, the hematologic parameters as well as CD4 count were gradually increased every year during the long term oxymetholone therapy until transfusion was finally unnecessary although the viral load had never been studied through the follow-up period. The present hematologic parameters were: Hb 13.0 g%, WBC 5,300/mm³, platelet 24,000/mm³, and CD4 526/mm³. Our case seemed to slowly increase the CD4 count during the oxymetholone treatment without side effects although the anti-retroviral therapy was withheld.