Anemia and thrombocytopenia in people living with HIV/AIDS: a narrative literature review

Abstract

<jats:title>Abstract</jats:title> <jats:p>Hematologic changes are frequent complications in people living with HIV/AIDS (PLWHA). Anemia and thrombocytopenia are the most frequent multifactorial hematologic abnormalities and are associated with a low quality of life and high death rates. This study aims to describe the prevalence of anemia and thrombocytopenia in PLWHA and to identify the main clinical characteristics that aggravate these conditions in studies published in the last 10 y. A comprehensive search was performed on the PUBMED database, using the terms ‘HIV infection and anemia’ and ‘HIV infection and thrombocytopenia’. Additional searches were made in the reference lists of articles covering the theme. The selected studies reported an overall prevalence of anemia from 7.2% to 84% and of thrombocytopenia from 4.5% to 26.2%. The prevalence of thrombocytopenia and anemia were aggravated by a CD4+ T lymphocyte count of &amp;lt;200 cells/μL, increased viral load and coinfections or opportunistic infections. Antiviral therapy (ART) shows a beneficial effect, reducing the frequencies of thrombocytopenia and anemia, except in a zidovudine-based ART regimen, which worsens the anemic condition. Because anemia and thrombocytopenia are treatable comorbidities associated with increased mortality among PLWHA, physicians should monitor these risk factors in order to establish better interventions and reduce morbidity and mortality in PLWHA.</jats:p>

Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study

“…CD4+ T-cell counts <200 cells/µL were found to be associated with the major hematological abnormality (cytopenia) that might be in association with higher plasma viral load and reported mainly as independently associated with an increased risk of developing anemia characterized by peripheral immunosuppression and a significant decrease in bone marrow hematopoietic activity. 44 This is in keeping with studies conducted in India, Cameroon, and Ethiopia. 8 , 17 – 20 , 55 , 56 , 62 , 63 , 66 – 68 This progressive depletion in CD4+ T-lymphocytes is the fundamental finding during disease advancement, eventually leading to marked immunosuppression and development of AIDS, causing immunological deterioration of infected individuals before initiation of treatment, but could also be due to the direct and indirect effect of the virus, the toxicity of the drugs, and OIs.…”

“… 19 , 42 , 43 , 69 The decrease in or diminished expected increment in RBC count after treatment initiation is explained by the cause of medication-induced anemia, as ZDV is mainly associated with myelotoxicity possibly by inhibiting erythroid precursor cells in the bone marrow leading to decreased RBC production manifesting in anemia. 44 , 70 , 71 …”

The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

“…Hematological abnormalities such as anemia, thrombocytopenia, leucopenia, coagulopathy, neutropenia, and vascular malignancies are encountered in people living with HIV/AIDS [ 7 , 8 , 30 ]. Different mechanisms such as the direct intracellular effect of viral infection, increased peripheral destruction of blood cells, interaction with viral proteins at the surface, perturbation of cytokine network, and bone marrow suppression by opportunistic infection are involved in hematological disorders among people living with the virus [ 9 , 31 ].…”

“…The low prevalence of thrombocytopenia among HAART users might be due to the role of HAART in reducing the viral load and improving CD4 T cell count. Highly active antiretroviral therapy is also reported to have a direct role in lowering thrombocytopenia [ 30 ]. Although cases are frequently observed, thrombocytopenia typically improved with the use of HAART [ 36 ].…”

Platelets in HIV: A Guardian of Host Defence or Transient Reservoir of the Virus?

“…Immune thrombocytopenia purpura may also occur in HIV-1 infection (30,31). Platelets (with viral loads) are cleared from the circulation and have shortened survival rates, which ultimately also result in thrombocytopenia (32)(33)(34). Additionally, platelets can adhere to endothelial cells, creating an adhesion molecule-dense area with which leukocytes can interact and perform immune functions (35).…”