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Background: HIV infection is associated with a wide range of haematological abnormalities, which are amongst its most common complications. This study aims at discerning the peripheral haematological abnormalities associated with HIV infection and to correlate them with CD4 cell count.Methods: An observational cross-sectional study was conducted from March 2017 till August 2018. 109 patients in 15 years or more age group who were HIV positive by the NACO guidelines were included. Complete hemogram, serum iron studies, serum folate and vitamin B12 levels, and flowcytometric CD4 cell count analysis were done for all the patients. Various haematological parameters were compared between the patients with CD4 cell counts <200/µl (n=52) to those with counts >200/µl (n=57). By using student t-test, the p-value was calculated for various parameters.Results: Anaemia (58.7%), leucopenia (27.5%) and thrombocytopenia (17.4%) were seen with anaemia being the most common abnormality. Normocytic normochromic anaemia (65.6%) was the predominant type of anaemia. Overall analysis showed a statistically significant difference between two groups in haemoglobin concentration, RBC indices, serum ferritin values and absolute lymphocyte count; with p-value <0.05.Conclusions: The diagnosis and treatment of haematological disorders are essential in medical care of the HIV-infected patients. Thus, in resource limited setups, where CD4 count analysis is not possible, haematological abnormalities can be used as tools for monitoring HIV positive individuals and can aid in the treatment of the patients.

BackgroundNeurological complications as the presenting feature of PHI are rare and reported in <10% of cases. We describe two cases of sero-conversion illness with rapidly progressive neurological involvement.Case 1A 43-year-old man presented with diarrhoea, vomiting and rash. On examination he had widespread lymphadenopathy, mouth ulcers and tender hepatomegaly. HIV test was positive (avidity index 50%). 2 weeks later he was readmitted with headache and vomiting. On examination he had left sided weakness and left facial droop. CT head was normal. Cerebro-spinal fluid (CSF) showed an elevated protein 2.99 g/l, WC 48, with and numerous polymorphs visualised. Antibiotics for meningitis were commenced. Serial MRI scans were normal. CD4 count was 640 cell/mm and HIV viral load was 197 000. Antiretrovirals (ARV) were commenced at day 14 and symptoms improved within the next 4 days. 2 months later all weakness and headaches have resolved.Case 2A 47-year-old British man presented with a collapse following 2 days of personality change and confusion and 10 days of fever, headaches, diarrhoea, myalgia, photophobia and rash. On admission he was confused, pyrexial with a Glasgow Coma Score of 13. He had a normal CT head, CSF protein was 1.5 g/l, RC <5, WC<5, with no organisms seen. Subsequent CSF viral PCR was negative. MRI brain was also normal. No evidence of sepsis was identified. An HIV test on admission was positive (avidity index 65%). HIV test 3 months earlier had been negative. CD4 count was 594 (16%) cells/mm3and viral load 462 756 copies/ml. ARVs were commenced on day 7, symptoms improved markedly over the following week. Four weeks post discharge confusion had completely resolved but he reported ongoing mild coordination difficulties.DiscussionNeurological complications of seroconversion are rare but do occur. Early recognition is important through prompt HIV testing and the introduction of ARVs may reduce the incidence of neurological sequelae markedly.

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