A Rare Case Report of Polycythemia in a male on Long-Term ART - Think Beyond the common causes.
Clinicians should be aware that polycythemia can occur in patients on Dolutegravir-based ART and should monitor hematological parameters regularly.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
A 12-year-old male with perinatally acquired HIV developed persistent polycythemia after starting a Dolutegravir-based ART regimen. Hemoglobin levels increased to 18.3 g/dL, necessitating therapeutic phlebotomies. The case underscores the need for monitoring hematological parameters in patients on INSTI-based therapies.
Abstract
Perinatally acquired Human Immunodeficiency Virus (HIV) infection is associated with several haematological abnormalities, most commonly anemia. Polycythemia is not a well known adverse effect of these drugs, particularly with integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART). We report a 12-year-old male with perinatally acquired HIV infection developing persistent polycythemia after initiation of a Dolutegravir (DTG)-based regimen. Hemoglobin levels steadily increased to 18.3 g/dL. Exclusion of both primary and secondary causes of erythrocytosis, including JAK2 mutation analysis, serum erythropoietin levels, bone marrow examination, hypoxia, and cardiac disease, was unremarkable. The patient required multiple therapeutic phlebotomies and low-dose aspirin for thrombosis prophylaxis. ART modification was limited by intolerance to alternative regimens, necessitating continuation of DTG therapy. This case highlights a rare but clinically significant adverse effect of DTG-based ART and emphasises the importance of regular hematological monitoring in patients receiving INSTI-containing regimens.