Samantha Vogt, M.D., M.P.H., Richard D. Moore, M.D.


  • 1-yr incidence ranges from 1.7% with asymptomatic HIV to 3.1% with CD4-define AIDS to 8.7% with AIDS-defining illness.
  • Increased risk with decreasing CD4, injection drug use, African-American race, anemia. Other causes include alcohol abuse, sulfonamides, thiazides, folate and vitamin B12 deficiency, IV cocaine, and liver cirrhosis / portal hypertension.
  • Direct effects of HIV on hematopoietic progenitors and idiopathic thrombocytopenic purpura (ITP) are major causes. In the latter, production of autoantibodies against certain platelet antigens (PA-IgG) leads to antibody-coated platelets removed by macrophages in the spleen.
  • Increased risk of bleeding with PLT < 10,000-20,000.
  • Heparin-induced thrombocytopenia may be more common in HIV-infected than uninfected.
  • Uncommon with current ART (1-3% with plt < 50,000); more common if uncontrolled HIV replication and with viral hepatitis coinfection

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Last updated: March 12, 2023