Endocrine Abstracts

Introduction: Up to 70% of adults living with human immunodeficiency virus (HIV) have excessive weight due to side effects of antiretroviral therapy (ART). Liraglutide is a licenced GLP-1 receptor agonist for the treatment of obesity in adolescents. However, there are no studies on effectiveness and safety of GLP-1 receptor agonists in patients on ART as these patients are excluded from most of the clinical trials. Herein, we present a teenage girl with HIV who developed thrombocytopenia after commencing Liraglutide treatment.

Clinical case: A 15-year-old female on ART for perinatally acquired HIV was referred to the endocrine team with excessive weight gain since the age of 7 years. The patient had been on the dolutegravir containing ART regimen for the previous 2 years with normal CD4 levels and undetectable HIV viral load. She had also suffered with intermittent episodes of non-bloody diarrhoea for >2 years, cause was unknown. Examination revealed normal height of 163.4 cm (SDS 0.13), excessive weight of 131 kg (SDS 7.66) with a very high BMI of 49.1 kg/m² (SDS +4.05). She had no clinical features that indicated underlying endocrine causes for the obesity. As the lifestyle changes were not successful due to complex social circumstances, the patient was commenced on Liraglutide at the dose of 0.6 mg/day which was gradually increased to 1.8 mg/day. Liraglutide helped to reduce her appetite, but she complained about bruising at the injection sites. Three weeks after commencing Liraglutide, a drop of platelet count was noticed (from 312x10⁹/l to 27x10⁹/l). A week after Liraglutide was stopped, platelet count increased to 41x10⁹/l. Full blood count showed normal level of erythrocytes and moderately increased leucocytes and lymphocytes. Past medical history revealed previous drop of platelet count during Epstein-Barr virus (EBV) infection at the age of 8 years (repeat PCR for EBV is pending).

Conclusion: Liraglutide has successfully decreased appetite in our patient with significant obesity and stable on ART. The patient is keen to recommence treatment. The cause of thrombocytopenia is unclear. Immune thrombocytopenia due to an intercurrent viral infection is plausible. To the best of our knowledge, Liraglutide-related thrombocytopenia has not been previously reported.