Prevalence of anemia in renal insufficiency among HIV infected patients initiating ART at a hospital in Northeast Ethiopia

Fiseha, Temesgen; Tamir, Zemenu; Seid, Abdurahaman; Demsiss, Wondmagegn

doi:10.1186/s12878-017-0071-2

Cited by 17 publications

(21 citation statements)

References 24 publications

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“…Renal impairment was a frequent finding among our study patients and has been linked to HIV disease progression, anaemia and poor outcomes in both wealthy and resource limited settings (52–55). Evaluation of renal function is an important component of severe anaemia treatment protocols (30, 53) since it may affect the choice of ART (52, 56).…”

Section: Discussionmentioning

confidence: 90%

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Huibers

Bates

McKew

et al. 2019

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Background: Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology is lacking and needed to improve outcomes. Methods:HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes of severe anaemia of anaemia and associations with anaemia severity and mortality were explored.Results: 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. Over two potential causes for anaemia were present in 94% of the patients;including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB-infection (41.2%) andunsuppressed HIV-infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 16 days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2). Conclusion: Mortality among severely anaemic HIV-infected adults is strikingly high.Clinicians must be aware of the urgent need for a multifactorial approach, including starting or optimising HIV treatment; considering TB treatment, nutritional support and attention to potential renal impairment. 109HIV-infected patients with anaemia, especially in resource limiting settings, are scarce. 110Only three of our study patients had confirmed bone marrow malignancies. In contrast 111 MDS was common occurring in 27% of our patients (27, 51). 112Renal impairment was a frequent finding among our study patients and has been 113 linked to HIV disease progression, anaemia and poor outcomes in both wealthy and 114 resource limited settings (52-55). Evaluation of renal function is an important component 115 of severe anaemia treatment protocols (30, 53) since it may affect the choice of ART (52,

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Section: Discussionmentioning

confidence: 90%

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Huibers

Bates

McKew

et al. 2019

Preprint

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“…Of the total 20 articles, more than one third of studies were conducted in Amhara regional state health institutions [2, 14, 18, 20, 23, 24, 26, 28]; four studies in Addis Ababa health institutions [13, 16, 21, 22]; four studies at South Nations Nationalities and peoples of Ethiopia national regional state (SNNP) [3, 15, 17, 34]; one study at Oromia national regional state [19], one study at Gambella national regional state [27], one study at Tigray regional national state [35] and one study at Dire Dawa town administration of Ethiopia [25]. …”

Section: Resultsmentioning

confidence: 99%

“…Based on this recommendation, a number of researches were done and reported that the prevalence of anemia among HIV infected adult individuals was:11.2% at northwest parts of Ethiopia in 2014 [3], 11.4% at Addis Ababa in 2018 [13],11.5% at northwest parts of Ethiopia in 2014 [14], 12% at southern parts of Ethiopia in 2005–2010 [15],14.3% at Addis Ababa in 2011/2012 [16], 22.6 at southern parts of Ethiopia in 2016 [17], 23%at northwest parts of Ethiopia in 2015 [18], 23.1% at Southwest parts of Ethiopia in 2012 [19], 25% at Northwest parts of Ethiopia in 2016 [20], 32.48% at Addis Ababa in 2011/2012 [21], 33% at Addis Ababa in 2008–2012 [22], 34.4% at northeast parts of Ethiopia in 2010–2013 [23], 35% at northwest Ethiopia in 2011/2012 [24], 41.2% at Eastern parts of Ethiopia in 2014 [25], 43% at northwest parts of Ethiopia in 2012/2013 [26], 51.74% at Gambella region in Southwest parts of Ethiopia in 2014 [27], 53.3% in Southern parts of Ethiopia in 2016–2013 [3] and 70.1% at northwest parts of Ethiopia in 2011/2012 [28]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis

et al. 2018

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BackgroundAnemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level.MethodsStudies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively.ResultA total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M2 with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors.ConclusionThis review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.

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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%

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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Prevalence of anemia in renal insufficiency among HIV infected patients initiating ART at a hospital in Northeast Ethiopia

Cited by 17 publications

References 24 publications

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis

HIV and haematopoiesis

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