Background

Zidovudine (AZT) is a crucial antiviral medication widely used in treating acquired immune deficiency syndrome (AIDS). While anaemia is a recognized side effect usually appearing within the first month of therapy, a shocking case has emerged where a patient developed severe aplastic anaemia, an exceedingly rare blood disorder, after being on zidovudine for 11 long years. This case sets a precedent, as it appears to be the first documented instance of severe aplastic anaemia attributed to the prolonged application of zidovudine.

Case Presentation

A 28-year-old male with a long history of AIDS presented to the emergency room complaining of pronounced fatigue and episodes of falling. Upon medical evaluation, he was found to have critically low haemoglobin levels of 31 g/L and a red blood cell (RBC) count of 0.89 × 10^12/L. Comprehensive examinations ruled out other potential causes, including gastrointestinal bleeding and autoimmune disorders. After assessing the potential link between zidovudine and the patient's condition, it was determined that there was a high likelihood of a causal relationship, with a Naranjo score of 8.

Given the drug's known propensity for bone marrow suppression, the decision was made to discontinue zidovudine. The patient was subsequently placed on alternative antiviral therapies, specifically lamivudine and dolutegravir sodium tablets. With treatment, his condition markedly improved, leading to a noticeable increase in haemoglobin levels and RBC counts within two weeks.

Follow-Up and Recovery

Six weeks post-discharge, the patient’s haemoglobin level rose to 156 g/L, normalizing his condition and effectively resolving the anaemia. This remarkable recovery underscores the necessity of vigilant monitoring of patients on long-term zidovudine therapy, ideally through regular blood tests to assess for anemia that could develop anytime during treatment.

Global Context

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), approximately 39 million people live with HIV worldwide as of 2023. Despite the great strides made in treatment leading to a dramatic drop in AIDS-related mortality, complications such as anaemia are on the rise. A staggering 46.6% of adults living with HIV are reportedly affected by anaemia, which could pose significant treatment challenges.

Several underlying factors contribute to anaemia in this demographic, including the impact of HIV on the bone marrow, nutritional deficiencies, opportunistic infections, and side effects from antiretroviral therapies like zidovudine. The irony lies in the fact that while zidovudine plays a pivotal role in managing HIV, it can also ensue severe adverse effects if used without proper monitoring.

Key Takeaways

This case serves as an alarm for health professionals and underscores the importance of thorough, ongoing patient evaluations—especially for those undergoing long-term zidovudine treatment. A proactive approach that involves frequent blood checks and differential diagnosis can help preempt severe complications.

Patients are urged to remain vigilant and communicate any signs of fatigue, dizziness, or unusual symptoms to their healthcare providers. As research continues, it becomes increasingly clear that the potential dangers of long-term zidovudine usage should not be underestimated. Ensuring patient safety can prevent life-threatening conditions like severe aplastic anaemia and improve the overall quality of life for those battling HIV.

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