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Thrombocytopenic purpura as first manifestation of human immunodeficiency virus type I (HIV-1) infection.

We report three cases of thrombocytopenic purpura associated with HIV-1 infection. The clinical picture is indistinguishable from classic autoimmune thrombocytopenic purpura (AITP). All three patients initially responded to treatment with high dose methylprednisolone. One patient had an incomplete remission on low dose prednisone, while another responded to zidovudine treatment. The third patient underwent splenectomy because he showed no response to treatment with low dose prednisone or zidovudine. The pathogenesis of HIV-associated thrombocytopenic purpura (HIV-TP) is still controversial. Two hypotheses are frequently mentioned: non-specific deposition of circulating immune complexes and complement versus specific auto-antibodies against platelets are suggested to be the cause of the increased clearance of platelets. In cases of severe thrombocytopenia, the therapy of first choice is initial high dose methylprednisolone, followed by either low dose prednisone in the presence of a relatively unaffected cellular immunity, or zidovudine, when the cellular immunity is already severely impaired.