Anti-GPIIIa antibody and CD4 count identify an autoimmune-enriched phenotype of HIV-associated thrombocytopenia: development and internal validation of a clinical nomogram - Summary - MDSpire
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Anti-GPIIIa antibody and CD4 count identify an autoimmune-enriched phenotype of HIV-associated thrombocytopenia: development and internal validation of a clinical nomogram
To develop a clinical prediction model for HIV-associated thrombocytopenia that distinguishes between autoimmune platelet destruction and advanced immunodeficiency.
Approach:
Study Design: A case-control study enrolling 196 HIV-infected individuals (98 thrombocytopenia cases, 98 controls) was conducted.
Model Development: Candidate predictors were identified through univariable analysis, and a multivariable model was constructed using AIC-based backward stepwise logistic regression.
Nomogram Creation: A nomogram was generated for bedside risk stratification, and model performance was assessed through bootstrap resampling and cross-validation.
Key Findings:
Anti-GPIIIa antibody positivity was the dominant predictor of thrombocytopenia (aOR = 35.3; 95% CI: 9.2–135.6; P < 0.001).
The final model achieved an AUC of 0.862 with high specificity (96.9%) and positive predictive value (95.6%).
Internal validation confirmed robustness with bootstrap-corrected AUC of 0.857.
Interpretation:
The nomogram identifies an autoimmune-enriched phenotype of HIV-associated thrombocytopenia, characterized by anti-GPIIIa positivity and reduced immune and hematological reserves.
Limitations:
Treatment response was not prospectively evaluated.
No independent reference standard was applied.
External validation and prospective studies are required before clinical implementation.
Conclusion:
The study provides a risk-stratification tool for identifying patients with an autoimmune-enriched thrombocytopenia phenotype.
