Incidence of Severe Neutropenia in HIV-Infected People Starting Antiretroviral Therapy in West Africa

Abstract

BackgroundIn sub-Saharan Africa, antiretroviral therapy (ART) including drugs with potential toxicity such as Zidovudine (ZDV) are routinely prescribed. This study aimed at estimating the incidence of severe neutropenia and associated factors after ART initiation in five West African countries.MethodsA retrospective cohort analysis was conducted within the international epidemiologic database to evaluate AIDS (IeDEA) collaboration in West Africa. All HIV-infected adults, initiating ART between 2002 and 2014, with a baseline and at least one follow-up absolute neutrophil count (ANC) measurement were eligible. Incidence of severe neutropenia (ANC <750 cells/mm3) was estimated with 95% confidence interval (CI) according to age, gender, HIV clinic, hemoglobin, CD4 count, clinical stage, and ART duration. A Cox proportional hazard model was used to identify factors associated with severe neutropenia, expressed with their adjusted hazard ratios (aHR).ResultsBetween 2002 and 2014, 9,426 HIV-infected adults were enrolled. The crude incidence rate of a first severe neutropenia was 9.1 per 100 person-years (95% CI: 8.6–9.8). Factors associated with severe neutropenia were exposure to ZDV <6 months (aHR = 2.2; 95% CI: 1.8–2.6), ≥6–12 months (aHR = 2.1; 95% CI: 1.6–2.8) and ≥12 months (aHR = 1.6; 95% CI: 1.2–2.2) [Ref. no ZDV exposure], CD4 count <350 cells/mm3 (aHR = 1.3; 95% CI: 1.1–1.5) and advanced clinical stage at ART initiation (aHR = 1.2; 95% CI: 1.0–1.4).ConclusionThe incidence of severe neutropenia after ART initiation in West Africa is high and associated with ZDV exposure and advanced HIV disease. In this context, efforts are needed to scale-up access to less toxic first-line ART drugs and to promote early ART initiation.

The Impact of Matrix Metalloproteinase-9 on the Sequential Steps of the Metastatic Process

“…Nausea, vomiting, diarrhea, headache and/or rash often occur in HIV-positive individuals taking HIV-reverse transcriptase inhibitors ( Table 2 ) [ 147 , 220 , 221 ]. Moreover, the long-term use of these drugs has been reported to cause neutropenia, anemia, myopathy, and liver or kidney malfunction ( Table 2 ) [ 147 , 220 , 221 ].…”

Prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia

“…Neutropenia is the most common leucopenia that occurs in 5-30% of patients with early symptomatic HIV infection and up to 70% of patients at advanced stages of AIDS [8,20,21]. Like other cytopenias, the cause of HIV-associated neutropenia is multifactorial, including a direct consequence of HIV infection, autoimmune disorders, opportunistic infections, malignancies, and drugs used to treat HIV and opportunistic infections like antiretroviral therapy (particularly zidovudine-containing regimens), cotrimoxazole, and others, which are myelotoxic [20,22,23].…”

Interactions of HIV and Antiretroviral Therapy With Neutrophils and Platelets

“…HIV-infected individuals have been reported to present with decreased counts of circulating neutrophils (neutropenia) compared to their uninfected counterparts with neutrophil counts dropping further with disease progression (23)(24)(25). HIVmediated cytotoxicity of progenitor cells and other leukocytes is considered to contribute to the observed neutropenia through reduced neutrophil production in the bone marrow (13).…”

“…In this context, investigation of the hematological profiles of a cohort of individuals receiving cART at a Nigerian teaching hospital revealed higher frequencies of leukopenia and neutropenia (52). Another study in West Africa also reported that HIV-infected persons initiating a cART regimen that included zidovudine, exhibited severe neutropenia associated with advanced HIV disease (25). These adverse effects of zidovudine result from bone marrow toxicity and myelosuppression (54).…”