HIV ITP Management — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostHIV ITP ManagementSCE Infectious Diseases

A 40-year-old man with HIV develops immune thrombocytopenic purpura (ITP). He has been on effective ART for 2 years (CD4 480, VL <50). His platelet count is 18 × 10⁹/L with mucosal bleeding. What is the initial management?

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Correct answer: A — Corticosteroids (Prednisolone 1 mg/kg) plus IVIG if severe bleeding — standard ITP management applies; ART should continue; HIV-associated ITP often responds to ART alone but this patient is already on ART

HIV-associated ITP is an autoimmune thrombocytopenia where anti-platelet antibodies destroy platelets. In many cases, ART initiation alone resolves ITP through reducing viral antigen-driven immune complex formation. In this patient already on effective ART, treatment follows standard ITP guidelines: (1) corticosteroids (Prednisolone 1 mg/kg for 1-2 weeks then taper), (2) IVIG (1 g/kg) for severe bleeding or urgently required procedures, (3) second-line: Rituximab, TPO agonists (Eltrombopag, Romiplostim). Splenectomy is a last resort.

Reference: BSH 2024 – ITP; BHIVA 2022 – Haematological complications of HIV