Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas

Abstract

Summary Background Hematological abnormalities are common manifestations of advanced HIV-1 infection that could affect the outcomes of highly-active antiretroviral therapy (HAART). Although most HIV-1-infected individuals live in resource-constrained countries, there is little information about the frequency of hematological abnormalities such as anemia, neutropenia, and thrombocytopenia among individuals with advanced HIV-1 disease. Methods This study compared the prevalence of pre-antiretroviral therapy hematological abnormalities among 1571 participants in a randomized trial of antiretroviral efficacy in Africa, Asia, South America, the Caribbean, and the USA. Potential covariates for anemia, neutropenia, and thrombocytopenia were identified in univariate analyses and evaluated in separate multivariable models for each hematological condition. Results The frequencies of neutropenia (absolute neutrophil count ≤ 1.3 × 109/l), anemia (hemoglobin ≤ 10 g/dl), and thrombocytopenia (platelets ≤ 125 × 109/l) at initiation of antiretroviral therapy were 14%, 12%, and 7%, respectively, and varied by country (p < 0.0001 for each). In multivariable models, anemia was associated with gender, platelet count, and country; neutropenia was associated with CD4+ lymphocyte and platelet counts; and thrombocytopenia was associated with country, gender, and chronic hepatitis B infection. Conclusions Differences in the frequency of pretreatment hematological abnormalities could have important implications for the choice of antiretroviral regimen in resource-constrained settings.

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.…”

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

“…An investigation in South Korea found that the leading risk factor for cytopenia was AIDS status at initial presentation (12). Another study showed that neutropenia was associated with CD4 and platelet counts; and that thrombocytopenia was associated with country, gender, and chronic hepatitis B infection (16). However, studies in India (17) and Rwanda (5) did not find a significant correlation between thrombocytopenia and low CD4 count.…”

Letter to the Editor

“…However, some facts should be noted. First, in a recent publication it is mentioned that HIV does not increase the risk of anaemia among the pregnant (2) . This report might be discordant with Finkelstein et al's finding that immunity, specifically CD4 T-cell count, can take a role.…”