Prevalence of cytopenias in both HAART and HAART naïve HIV infected adult patients in Ethiopia: a cross sectional study

Abstract

BackgroundIn individuals infected with HIV, hematological abnormalities are common and are associated with increased risk of disease progression and death. However, the profile of hematological abnormalities in HIV infected adult patients is not known in Ethiopia. Thus, the aim of this study was to assess the hematological manifestations of HIV infection and to identify the factors associated with cytopenias in both HAART and HAART naïve HIV infected adult patients in Ethiopia.MethodWe conducted a cross-sectional quantitative study of HIV-infected adult patients attending the ART follow-up clinic of Jimma University Specialized Hospital in Jimma, Ethiopia, from July 2012 to September 2012. We used a structured questionnaire to collect socio-demographic and clinical information. After interviewing, 4 ml of venous blood was drawn from each study subject for hematologic and immunologic parameters.ResultThe prevalence of anemia, leucopenia, thrombocytopenia and lymphopenia among the study individuals were 51.5%, 13%, 11.1% and 5% respectively. Presence of opportunistic infection (p = 0.001), use of CPT (p = 0.04) and CD4 count < 200 cells/μl (p = 0.002) were associated with an increased risk of anemia.ConclusionHematologic abnormalities were common in HIV infected adult patients. Of the cytopenias anemia was the most common. Use of CPT was independently associated with increased risk of anemia and leucopenia. Therefore, large scale and longitudinal studies, giving emphasis on the association of CPT and cytopenia, are recommended to strengthen and explore the problem in depth.

HIV and haematopoiesis

“…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.…”

“…Severe cytopenias, especially anaemia and thrombocytopenia, are associated with increased morbidity and poorer quality of life. [7,10,17] HIVassociated haematological abnormalities should be managed appropriately by healthcare providers. [4,5] The diagnosis and treatment of haematological abnormalities in HIV-infected individuals have been comprehensively reviewed elsewhere.…”

“…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.…”

“…2). [7] Factors causing anaemia in HIV-infected individuals can broadly be divided into three main categories: (i) decreased red blood cell (RBC) production in the BM; (ii) increased RBC destruction; and (iii) ineffective RBC production due to nutritional deficiencies [31] (Fig. 2).…”

The multifactorial pathogenesis of severe central anemia in a cohort of HIV‐positive patients

“…A pancytopenia was present in 11.2% A recent South African study showed that severe anemia is inversely related to cART exposure 10 while other studies have shown that cART improves anemia 8,11 and that increase in CD4 count correlates with improvement of anemia. 12 In this study however, almost one third of patients were virally suppressed and 12.6% of patients had CD4 counts of >350 cells/µL. However, the predominant causes of severe anemia in the group of patients with CD4 counts of >350 cells/µL were not due to the immune-dysregulating effects of HIV but rather due to causes which may be present in patients with adequate immune reconstitution-namely PRCA (which may be cART drug related), nutritional deficiency, and BM infiltration.…”