Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A crosssectional study

Gunda, Daniel W.; Godfrey, Kahamba G; Kilonzo, Semvua B.; Mpondo, Bonaventura C. T.

doi:10.4314/mmj.v29i1.9

Cited by 24 publications

(55 citation statements)

References 62 publications

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“…There are no published reports available from Frenchspeaking countries in the eastern and southern sub-Saharan African region. These countries include: Ethiopia (10 reports); [6][7][8][9][10][11][12][13][14][15] Malawi (1 report); [16] SA (6 reports); [17][18][19][20][21] Rwanda (1 report); [22] Tanzania (1 report); [23] Uganda (4 reports); [24][25][26][27] and Zimbabwe (1 report). [19] The size of the cohorts ranged from 30 -15 030 patients.…”

Section: Haematological Abnormalitiesmentioning

confidence: 99%

“…3) in the treatment-naïve cohorts studied. [6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30] The severity of anaemia is often used as an indicator of a poor prognosis in resource-poor settings, independent of the CD4 count. This practice should be discouraged as some causes of anaemia, such as nutritional deficiencies, are unrelated to HIV infection and disease stage ( Fig.…”

Section: Anaemiamentioning

confidence: 99%

“…3) in the treatment-naïve cohorts studied. [7,8,11,12,[21][22][23][24][25][26] Although the prevalence and severity of thrombocytopenia is associated with disease stage, the relationship is not always linear as newly infected patients with HIV may also present with thrombocytopenia. [4] Thrombocytopenia is also more frequently…”

Section: Thrombocytopeniamentioning

confidence: 99%

“…2). [13,23,25] In addition, neutropenia severity is related to risk of opportunistic co-infection, with a count below 1 ×10 9 neutrophils/L indicating a significantly increased risk. [4] Benign, ethnic neutropenia has a high prevalence in individuals of African descent.…”

Section: Hiv-associated Neutropeniamentioning

confidence: 99%

“…Prevalence of cytopenias reported in HIV-infected, treatment-naive cohorts. Scatter dot plot is used to illustrate the percentage ranges reported in 22 (anaemia), [6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30] 8 (thrombocytopenia) [7,8,11,12,[21][22][23][24][25][26] and 6 (neutropenia) [7,8,19,21,22,25,30]…”

Section: Direct Effect Of Hiv On Haematopoiesis: Suggested Mechanismsmentioning

confidence: 99%

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HIV and haematopoiesis

et al. 2019

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Human immunodeficiency virus (HIV) infection not only leads to a compromised immune system, but also disrupts normal haematopoiesis, resulting in the frequent manifestation of cytopenias (anaemia, thrombocytopenia and neutropenia). Although there is a definite association between the severity of cytopenia and HIV disease stage, this relationship is not always linear. For example, cytopenias such as thrombocytopenia may occur during early stages of infection. The aetiology of these haematological abnormalities is complex and multifactorial, including druginduced impaired haematopoiesis, bone marrow suppression due to infiltration of infectious agents or malignant cells, HIV-induced impaired haematopoiesis, and several other factors. In this review, we describe the frequencies of anaemia, thrombocytopenia and neutropenia reported for HIV-infected, treatment-naïve cohorts studied in eastern and southern sub-Saharan African countries. We present a rational approach for the use of diagnostic tests during the workup of HIV-infected patients presenting with cytopenia, and discuss how HIV impacts on haematopoietic stem/progenitor cells (HSPCs) resulting in impaired haematopoiesis. Finally, we describe the direct and indirect effects of HIV on HSPCs which result in defective haematopoiesis leading to cytopenias. S Afr Med J 2019;109(8 Suppl 1):S41-S46. https://doi.org/10.7196/SAMJ.2019.v109i8b.13829 Fig. 1. Schematic illustration of the differentiation of haematopoietic stem/progenitor cells (HSPCs) into mature blood cell types. (MPP = multipotent progenitor; CMP = common myeloid progenitor; CLP = common lymphoid progenitor; MEP = megakaryocyte-erythroid progenitor; GMP = granulocytemacrophage progenitor; NK = natural killer cell.)

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Section: Haematological Abnormalitiesmentioning

confidence: 99%

Section: Anaemiamentioning

confidence: 99%

Section: Thrombocytopeniamentioning

confidence: 99%

Section: Hiv-associated Neutropeniamentioning

confidence: 99%

Section: Direct Effect Of Hiv On Haematopoiesis: Suggested Mechanismsmentioning

confidence: 99%

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HIV and haematopoiesis

et al. 2019

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Prevalence of anemia among people living with HIV: A systematic review and meta-analysis

Cao

Wang

et al. 2022

eClinicalMedicine

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Background Anemia is the most frequent hematologic abnormality among people living with human immunodeficiency virus (HIV) (PLWHIV) and is associated with HIV disease progression and higher risk of mortality of the patients. However, there is a wide variation of the prevalence of anemia among PLWHIV in different clinical settings. We aimed to obtain more precise estimates of prevalence of anemia and severity of anemia among PLWHIV, which may be important for patients, caregivers, researchers and health policy-makers.Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for original articles reporting the prevalence of anemia defined using age and sex-specific hemoglobin levels according to World Health Organization criteria among PLWHIV from inception to August 31, 2021. We used DerSimonian-Laird randomeffects meta-analyses to obtain pooled prevalence and 95% confidence intervals (CIs) of anemia and severity of anemia among PLWHIV. A univariable meta-regression has been conducted to assess the association between anemia prevalence and study characteristics, including study design, median year of sampling, geographical region, World Bank Income level, and proportion of antiretroviral therapy (ART). FindingsWe included 63 observational studies covering 110,113 PLWHIV. The pooled prevalence of anemia was 39.7% (95% CI: 31.4%-48.0%) for children living with HIV aged <15 years, 46.6% (95% CI: 41.9%-51.4%) for adults (men and non-pregnant women) living with HIV aged ≥15 years, and 48.6% (95% CI: 41.6%-55.6%) for pregnant women living with HIV. Among adults living with HIV, the pooled prevalence of severity of anemia was 21.6% (95% CI: 19.9%-23.3%), 22.6% (95% CI: 14.8%-30.4%), and 6.2% (95% CI: 4.4%-8.1%) for mild, moderate and severe anemia, respectively. Compared with East Africa, anemia prevalence among adults living with HIV was higher in Southern Africa (p = 0.033).Interpretation Anemia is prevalent among PLWHIV. Thus, policies, strategies, and programs should be considered to identify the predictors of anemia among PLWHIV to reduce the burden of anemia among patients in the ART era.

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