Drug-dependent antibodies with immune hemolytic anemia in AIDS patients

We studied the presence of drug-dependent antibodies (D-DAbs) in 53 patients with AIDS who developed immune hemolytic anemia (IHA). We examined sera and eluates for the presence of D-DAbs. Drug antibodies were detected in 43.4 percent (23/53) of the patients with IHA. Antibodies to more than one drug were detected in 60.8 percent (14/23) of patients with drug-induced IHA (D-IHA). The DAT was positive by RBC-bound IgG in eight patients, RBC-bound IgG/C3d in nine, IgG/IgA in three, IgG/IgA/C3d in two, and one patient had RBC-bound C3d only. No drug-independent antibodies were detected. Our study demonstrates that patients with AIDS commonly develop D-DAbs. D-IHA should be included in the differential diagnosis of a falling Hb in AIDS patients receiving drugs.