Lamivudine induced pure red cell aplasia and HIV-1 drug resistance-associated mutations: a case report

Adverse effects linked to antiretroviral therapy (ART) may contribute to poor adherence on the patient's side. Consequently, human immunodeficiency virus (HIV) drug resistance mutations could emerge, negatively impacting the body's immune system. Meanwhile, severe immunosuppression can lead to several conditions, including anemia. The cause of anemia in HIV infection is multifactorial, and can be mainly explained by deleterious direct effects of the virus on the bone marrow, and opportunistic infections such as Parvovirus B19. Other causes include blood loss resulting from neoplasms and gastrointestinal lesions. Moreover, anemia can also be caused by antiretroviral drugs. We report a case of persistent anemia after ART initiation, kidney injury and treatment failure following a lengthy period of non-adherence to ART. The anemia was classified as Pure Red Cell Aplasia (PRCA). With treatment modification, the anemia resolved and the patient attained virologic suppression. Lamivudine (3TC) was pointed out as the cause of PRCA, which resolved after its withdrawal from the ART regimen. This rare side effect should be investigated in patients on 3TC who present with recurrent anemia.

Automated summary

Adverse effects of antiretroviral therapy (ART) can lead to poor adherence and HIV drug resistance mutations, negatively impacting the immune system. Anemia in HIV infection can have multiple causes, including direct effects of the virus on the bone marrow and opportunistic infections. ART drugs can also cause anemia. We report a case of persistent anemia, kidney injury, and treatment failure due to non-adherence to ART. The anemia was classified as Pure Red Cell Aplasia (PRCA) and resolved after treatment modification and withdrawal of lamivudine (3TC).