Date Published: February 13, 2019
Publisher: Public Library of Science
Author(s): Zemenu Tamir, Abdurahaman Seid, Haftay Haileslassie, Esaki M. Shankar.
Hematologic abnormalities involving peripheral blood cell cytopenias are strong predictors of morbidity, mortality and poor antiretroviral therapy (ART) outcomes of HIV infected individuals. However, limited studies are conducted in resource-limited settings of sub-Saharan Africa that have addressed the magnitude and associated factors of cytopenias. This study aimed to investigate the magnitude and associated factors of cytopenias among ART naïve HIV infected adult Ethiopians.
A cross-sectional study was conducted among ART naïve HIV infected individuals attending at ART unit of Dessie Referral Hospital between November 01, 2015 and April 30, 2016. A total of 402 adults were included using consecutive sampling. Socio-demographic, clinical and laboratory data of patients were collected. The data were entered to Epi Info version 3.4.3 and analyzed using SPSS version 20 software (SPSS INC, Chicago, IL, USA). Factors associated with cytopenias were analyzed first using bivariate and then multivariate logistic regression models. An odds ratio with 95% confidence interval was used to measure the strength of association. For all statistical significant tests, the cut-off value was set at P<0.05. In this study, the overall magnitude of any cytopenia, anemia, leucopenia and thrombocytopenia were 63.4%, 43.5%, 24.4% and 18.7%, respectively. In multivariate logistic regression analysis, severe immunosuppression and WHO clinical stage IV HIV disease were significantly associated with increased prevalence of cytopenias. In addition, older age and younger age showed significant association with increased prevalence of anemia and leucopenia, respectively. Frequent occurrence of cytopenias was independently associated with severe immunosuppression and WHO clinical stage IV HIV disease. Further longitudinal multicenter studies are recommended to bolster the findings of this study in order to suggest the need of routine assessment and management of hematological abnormalities for optimal choice of initial antiretroviral agents and prevention of further morbidities.
Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) encompass a clinical spectrum of diseases in which cytopenias of all blood cell lines are encountered especially in ART naïve patients [1, 2]. Cytopenias including anemia, leucopenia and thrombocytopenia are among the most common non immunological complications of HIV infection [3, 4]. The pathophysiological basis for the development of cytopenias may include impaired hematopoiesis, immune-mediated cytopenias, and coagulopathies especially in the advanced stage of the disease [5, 6].
This study was intended to assess the magnitude and associated risk factors of peripheral cytopenias among ART naïve HIV infected adults in a resource-scarce setting. Accordingly, it showed that at least one form of cytopenia was present among 63.4% of the study participants. Anemia was present among 43.5% of study participants followed by leucopenia (24.4%) and thrombocytopenia (18.7%). Prior study reports on HIV associated cytopenias among ART naïve individuals were less consistent with our findings. Studies conducted in Uganda , Nigeria  and South Korea  reported 65%, 59.8% and 11.2% of the study participants had at least one form of blood cytopenias, respectively. The difference might be due to variation in methodology of the research, socio-demographic and clinical characteristics of the study population and definition of cytopenias used in each study. For instance the South Korean study, which was conducted by analyzing patients data records retrospectively, had used strict exclusion criteria such as patients with opportunistic infections or other signs of infectious illness, with any malignancy or who had received chemotherapeutic agents within six months prior to enrollment or patients with medication history for agents which can induce cytopenias within two weeks before enrolment; it also defined anemia if Hgb concentration was less than 10g/dl .
This study showed high prevalence of peripheral blood cell cytopenias among ART naïve individuals living with HIV/AIDS in resource-limited settings. Lower CD4+ T-cell count and WHO clinical stage IV HIV disease were identified as independent predictors for presence of anemia, leucopenia and thrombocytopenia. Moreover, although the findings of the current study indicated the necessity of emphasizing on diagnosis and management of hematological abnormalities among ART naïve HIV infected individuals in order to provide an optimal choice of initial antiretroviral agents and to prevent further morbidities, additional multicenter longitudinal research is recommended to generalize the related outcomes of this study.