In addition to ADAMTS-13 deficiency and endothelial dysfunction, secondary triggers such as opportunistic infections (e.g., cytomegalovirus, Mycobacterium tuberculosis) and inflammatory conditions (e.g., immune reconstitution inflammatory syndrome (IRIS)) can further exacerbate the prothrombotic state in HIV patients predisposed to TTP [3]. Here, ADAMTS13 is linked to thrombotic thrombocytopenic purpura.