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CLINICAL PRESENTATION OF PARVOVIRUS B19 INFECTION IN ADULTS LIVING WITH HIV/AIDS: A CASE SERIES
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Abstract: Parvovirus B19 (B19V) infection varies clinically depending on the host’s immune status.
Due to red blood cell precursors tropism, B19V can cause chronic anemia and transient aplastic
crisis in patients with immunosuppression or chronic hemolysis. We report three rare cases of
Brazilian adults living with human immunodeficiency virus (HIV) with B19V infection. All cases
presented severe anemia and required red blood cell transfusions. The first patient had low CD4+
counts and was treated with intravenous immunoglobulin (IVIG). As he remained poorly adherent to
antiretroviral therapy (ART), B19V detection persisted. The second patient had sudden pancytopenia
despite being on ART with an undetectable HIV viral load. He had historically low CD4+ counts, fully
responded to IVIG, and had undiagnosed hereditary spherocytosis. The third individual was recently
diagnosed with HIV and tuberculosis (TB). One month after ART initiation, he was hospitalized with
anemia aggravation and cholestatic hepatitis. An analysis of his serum revealed B19V DNA and
anti-B19V IgG, corroborating bone marrow findings and a persistent B19V infection. The symptoms
resolved and B19V became undetectable. In all cases, real time PCR was essential for diagnosing
B19V. Our findings showed that adherence to ART was crucial to B19V clearance in HIV-patients and
highlighted the importance of the early recognition of B19V disease in unexplained cytopenias.
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