Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

Abstract

ObjectivesAlthough haematological abnormalities are common manifestations of HIV infection, few studies on haematological parameters in HIV-infected persons have been undertaken in sub-Saharan Africa. The authors assessed factors associated with haematological parameters in HIV-infected antiretroviral-naïve and HIV-uninfected Rwandan women.Study designCross-sectional analysis of a longitudinal cohort.SettingCommunity-based women's associations.Participants710 HIV-infected (HIV+) antiretroviral-naïve and 226 HIV-uninfected (HIV−) women from the Rwanda Women's Interassociation Study Assessment. Haematological parameters categorised as (abnormal vs normal) were compared by HIV status and among HIV+ women by CD4 count category using proportions. Multivariate logistic regression models using forward selection were fit.ResultsPrevalence of anaemia (haemoglobin (Hb) <12.0 g/dl) was higher in the HIV+ group (20.5% vs 6.3%; p<0.001), and increased with lower CD4 counts: ≥350 (7.6%), 200–349 (16%) and <200 cells/mm3 (32.2%). Marked anaemia (Hb <10.0 g/dl) was found in 4.2% of HIV+ and none of the HIV− women (p<0.001), and was highest in HIV+ women with CD4 <200 cells/mm3 (8.4%). The HIV+ were more likely than HIV− women (4.2 vs 0.5%, respectively, p=0.002) to have moderate neutropenia with white blood cells <2.0×103 cells/mm3 and 8.4% of HIV+ women with CD4 <200 cells/mm3 had moderate neutropenia. In multivariate logistic regression analysis, BMI (OR 0.87/kg/m2, 95% CI 0.82 to 0.93; p<0.001), CD4 200–350 vs HIV− (OR 3.59, 95% CI 1.89 to 6.83; p<0.001) and CD4 <200 cells/mm3 vs HIV− (OR 8.09, 95% CI 4.37 to 14.97; <0.001) had large independent associations with anaemia. There were large independent associations of CD4 <200 cells/mm3 vs HIV− (OR 7.18, 95% CI 0.78 to 65.82; p=0.081) and co-trimoxazole and/or dapsone use (OR 5.69, 95% CI 0.63 to 51.45; p=0.122) with moderate neutropenia.ConclusionsAnaemia was more common than neutropenia or thrombocytopenia in the HIV-infected Rwandan women. Future comparisons of haematological parameters in HIV-infected patients before and after antiretroviral therapy initiation are warranted.

The prevalence of HIV seropositivity and associated cytopenias in full blood counts processed at an academic laboratory in Soweto, South Africa.

“…[6,7] With regard to other studies conducted among South Africans, the prevalence of anaemia among ART-naive patients was similar to that reported by Kerkhoff et al, [10] (~70%), but higher than that documented by Takuva et al [11] and Firnhaber et al, [5] who both reported anaemia (Hb <10 g/dL) in ~20 -25% of patients (as opposed to ~40% with Hb concentrations in this range in our study). The generally higher anaemia prevalence observed in this study compared with the majority of other African cohorts may be attributable to the fact that many of the previous studies in this field were performed in patients who were either enrolled in clinical trials or seen at outpatient ART clinics.…”

“…The impact on haematology services is singularly notable because of the numerous haematological complications of HIV infection, which occur secondary to effects of the virus itself, as a result of associated opportunistic infections/malignancies, or as adverse drug effects. [1] Several studies have reported the prevalence of haematological complications in HIV-seropositive patients, [2][3][4][5][6][7] with variables such as disease stage and exposure to antiretroviral therapy (ART) being important determinants. [8] However, there is a paucity of published SA data in this regard, despite the fact that the burden of HIV infection in SA is among the highest in the world.…”

“…[9] Documenting the SA experience in this respect is important, as the prevalence of some cytopenias has been shown to vary geographically, with anaemia being more prevalent among treatment-naive patients with AIDS from Africa than among those from Asia or the Americas. [5] Furthermore, geographical differences have been reported within Africa, with the prevalence of anaemia in patients with immunological AIDS (iAIDS) being 32.2%, 49.3% and 58.0% in Rwanda, [6] Uganda [7] and Nigeria, [4] respectively. The prevalence of cytopenias in SA patients is therefore of interest.…”

Profile of Micronutrients, Electrolytes, Haematology and CD4 Count in HIV Infected Subjects on Highly Active Antiretroviral Therapy

“…We also observed a significant decrease (p < 0.05) in platelet count in HIV HAART naïve patients when compared to HIV HAART patients and controls. This is in agreement with the works of Munyazesa et al 36 and Vannappagari et al 41 who reported higher prevalence of thrombocytopenia in HIV-infected individuals. The marked reduction in platelet counts may directly be attributed to the ability of HIV to directly suppress platelet production by infecting megakaryocytes and indirectly suppress production by causing alterations in the production of cytokines (cell-produced chemicals) and growth factors needed for proper platelet production and function.…”

A cross-sectional study of leukopenia and thrombocytopenia among Chinese adults with newly diagnosed HIV/AIDS

“…Among these hematologic disorders, anemia is the most common hematologic manifestation (2,4,5). In different studies, the prevalence of anemia in individuals with AIDS has been reported at 63% to 95%, making it more common than thrombocytopenia or leukopenia in AIDS patients (6).…”