Prevalence and correlates of cytopenias in HIV-infected adults initiating highly active antiretroviral therapy in Uganda

Abstract

BackgroundCytopenias are the most common HIV-associated hematological abnormality. Cytopenias have been associated with several factors including sex, race/ethnicity, geographical location and comorbidities such as tuberculosis, hepatitis B infection, fever and oral candidiasis. Cytopenias become more prevalent as HIV progresses and are often fatal. Data from resource-limited settings about the prevalence and correlates of cytopenia are limited. Therefore we conducted this cross-sectional study to assess the prevalence and correlates of cytopenia among adult AIDS patients at initiation of HAART in Uganda.Methods400 HIV-infected subjects who were HAART-naïve or on HAART for ≤ 6 months were enrolled into the Multivitamins, HAART and HIV/AIDS Trial. Anemia was defined according to WHO guidelines as any hemoglobin concentration < 12 g/dl for non-pregnant females and < 13 g/dl for males. Leucopenia and thrombocytopenia were defined using study site laboratory reference ranges for lack of generally accepted definitions for these 2 cell lines as leucopenia if white blood cell count < 2.75 × 109 cells/litre and thrombocytopenia if platelets < 125 × 109 cells/litre for females and < 156 × 109 cells/litre for males. Univariate and bivariate analyses were done to describe the patient population and log-binomial regression was used to quantify the correlates of cytopenia.ResultsSixty five percent of the 400 subjects had at least one form of cytopenia. Anemia occurred in 47.8%, leucopenia in 24.3%, thrombocytopenia in 8.3%, bicytopenia in 21.9% and only 2 had a pancytopenia. Cytopenia was more prevalent in females (prevalence ratio [PR]:1.33, 95% confidence interval [CI]:1.12-1.59); CD4 count category 50 to <200 (PR: 0.75, 95% CI: 0.64 -0.88) and CD4 count category 200 to <350 (PR: 0.74, 95% CI: 0.59 - 0.92) compared to CD4 count category <50; normal BMI (PR: 0.82, 95% CI:0.68-1.00) and overweight BMI (PR: 0.64, 95% CI:0.50- 0.82) compared to underweight BMI and those with a history or presence of oral candidiasis.ConclusionsCytopenias are a frequent complication in HIV-infected adults at initiation of HAART in Uganda. The presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index. Prospective studies in resource-limited settings on the trend in HIV-related cytopenias are needed.

Anemia in combined antiretroviral treatment-naive HIV-infected patients in China: A retrospective study of prevalence, risk factors, and mortality

“…Lower BMI is related to malnutrition and nutrient deficiencies, including deficiencies of vitamin B12, folate, and iron, which directly result in anemia. Similar to prior findings (3,20), our results found a strong independent association between CD4 count ≤ 199 × 10 9 /L and anemia; this association was most pronounced in those with a CD4 count < 50 × 10 9 /L. We also demonstrated that higher baseline HIV viral loads were associated with anemia.…”

“…The guidelines for the use of antiretroviral agents in China (25) recommend initiation of cART at a CD4 count < 350 × 10 9 /L, or a CD4 count > 350 × 10 9 /L certain clinical criteria are met. Some studies documented that a CD4 count < 200 × 10 9 /L was associated with myelosuppression and anemia (20). Thus, initiating cART at a higher CD4 count threshold reduces the risk of anemia.…”

“…Hematologic abnormalities are reportedly the most common complications of advanced HIV infection (20), with anemia being the most common hematologic abnormality. Anemia affects a large proportion of those with advanced-stage HIV-infection.…”

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

“…Second, this was an observational study, we were able to examine potential associations but were not able to assess causation, so it is not clear if the cytopenias preceded the HIV infection or vice versa. Third, cytopenias are associated with several factors including geographical location and comorbidities such as tuberculosis, hepatitis B infection, fever and oral candidiasis (15), these factors were not assessed in our study. Therefore, we were not able to determine the association between these factors and the prevalence of cytopenias.…”

“…Leukopenia and thrombocytopenia were seen in 26.8% and 21.7% of HIV patients with CD4 counts less than 200 cells/mm 3 in India, respectively (14). Leukopenia and thrombocytopenia occurred in 24.3% and 8.3% of adult AIDS patients at initiation of ART in Uganda, respectively (15). The study in Uganda showed that the presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index.…”