{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:20:55Z","timestamp":1783405255043,"version":"3.54.6"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thrombocytopenia is a frequent complication of human immunodeficiency virus (HIV) infection, tire arising through diverse mechanisms including autoimmune platelet destruction, advanced immunodeficiency, and systemic comorbidities. Distinguishing thrombocytopenia driven primarily by autoimmune platelet destruction from that related to advanced immunodeficiency remains a clinical challenge, as current standard markers often fail to stratify these distinct pathophysiological phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a case-control study enrolling 196 HIV-infected individuals (98 thrombocytopenia cases, 98 controls) to develop a clinical prediction model for HIV-associated thrombocytopenia. Candidate predictors were identified through univariable analysis, and AIC-based backward stepwise logistic regression was used to construct a parsimonious multivariable model. A nomogram was generated for bedside risk stratification, and dose-response analysis examined CD4+ T-cell counts and anti-platelet autoimmunity. Model performance was assessed through bootstrap resampling and 10-fold cross-validation, calibration by the Hosmer-Lemeshow test, and clinical utility by Decision Curve Analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anti-GPIIIa antibody positivity emerged as the dominant predictor of thrombocytopenia (aOR = 35.3; 95% CI: 9.2\u2013135.6;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). The final 4-variable model\u2014incorporating anti-GPIIIa antibody, CD4+ count, albumin, and neutrophil count\u2014achieved AUC of 0.862 (95% CI: 0.811\u20130.913). At the optimal cutoff, the model demonstrated high specificity (96.9%) and positive predictive value (95.6%). Internal validation confirmed robustness, with bootstrap-corrected AUC of 0.857 (optimism = 0.005) and mean cross-validation AUC of 0.867 \u00b1 0.055. Dose-response analysis (CD4 \u2264600 cells\/\u03bcL; n = 167) revealed distinct risk trajectories: anti-GPIIIa-positive patients maintained consistently high thrombocytopenia risk (100% at CD4 &amp;lt;150 cells\/\u03bcL, declining to approximately 80% at CD4 &amp;gt;300 cells\/\u03bcL), whereas antibody-negative patients showed progressive risk reduction (from ~58% at CD4 &amp;lt;50 to ~17% at CD4 &amp;gt;380 cells\/\u03bcL); the CD4 \u00d7 anti-GPIIIa interaction was not statistically significant (P\u00a0=\u00a00.427).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This parsimonious model identifies an autoimmune-enriched phenotype of HIV-associated thrombocytopenia, characterized by anti-GPIIIa positivity and reduced immune and hematological reserves. Rather than confirming an immune-mediated etiology, the nomogram supports risk stratification to identify patients warranting further immunological evaluation. As treatment response was not prospectively evaluated and no independent reference standard was applied, external validation and prospective studies are required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1847525","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:46:56Z","timestamp":1783403216000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anti-GPIIIa antibody and CD4 count identify an autoimmune-enriched phenotype of HIV-associated thrombocytopenia: development and internal validation of a clinical nomogram"],"prefix":"10.3389","volume":"17","author":[{"given":"Xia","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Infection, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]},{"name":"Department of Gastrointestinal Endoscopy, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lemin","family":"Wen","sequence":"additional","affiliation":[{"name":"Laboratory of Traditional Chinese Medicine Clinical and Translational Medicine, Nanning Hospital of Traditional Chinese Medicine","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhoulin","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Nanning Blood Center","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hangbiao","family":"Qiang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Infectious Diseases, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lida","family":"Mo","sequence":"additional","affiliation":[{"name":"Key Laboratory of Infectious Diseases, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]},{"name":"Department of Clinical Laboratory, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyi","family":"Dong","sequence":"additional","affiliation":[{"name":"Key Laboratory of Infectious Diseases, HIV\/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People\u2019 s Hospital of Nanning","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Huang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Infectious Diseases, HIV\/AIDS Clinical Treatment 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