抗逆转录病毒治疗（ART）的不良影响可能导致患者依从性差。因此，人类免疫缺陷病毒（HIV）药物抗性突变可能出现，对身体的免疫系统造成负面影响。与此同时，严重的免疫抑制可能导致多种疾病，包括贫血。HIV感染引起贫血的原因是多种多样的，主要可以通过病毒对骨髓的有害直接影响以及类似巴维病毒B19的机会性感染来解释。其他原因包括由新生物和胃肠道损伤引起的失血。此外，抗逆转录药物也可能导致贫血。我们报道了一例ART开始后持续贫血、肾损伤和治疗失败的病例，这是由于长期不依从ART治疗引起的。该贫血被分为纯红细胞再生障碍（PRCA）。经治疗调整后，贫血得到缓解，并且患者获得了病毒学抑制。拉米夫定（3TC）被认为是PRCA的原因，它在ART方案中被撤出后得到了缓解。这种罕见的副作用应该在3TC患有反复贫血的患者中进行调查。©作者（S）2023。由牛津大学出版社出版。

Adverse effects linked to antiretroviral therapy (ART) may contribute to poor adherence on the patient's side. Consequently, human immunodeficiency virus (HIV) drug resistance mutations could emerge, negatively impacting the body's immune system. Meanwhile, severe immunosuppression can lead to several conditions, including anemia. The cause of anemia in HIV infection is multifactorial, and can be mainly explained by deleterious direct effects of the virus on the bone marrow, and opportunistic infections such as Parvovirus B19. Other causes include blood loss resulting from neoplasms and gastrointestinal lesions. Moreover, anemia can also be caused by antiretroviral drugs. We report a case of persistent anemia after ART initiation, kidney injury and treatment failure following a lengthy period of non-adherence to ART. The anemia was classified as Pure Red Cell Aplasia (PRCA). With treatment modification, the anemia resolved and the patient attained virologic suppression. Lamivudine (3TC) was pointed out as the cause of PRCA, which resolved after its withdrawal from the ART regimen. This rare side effect should be investigated in patients on 3TC who present with recurrent anemia.© The Author(s) 2023. Published by Oxford University Press.