Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia

Abstract

IntroductionThere are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high.ObjectiveThe aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART.MethodologyA cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version.ResultsThe median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm3 with an IQR of (286, 765); this increased to 663 cells mm3 with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×103 with an IQR of (2.1, 4.6) and after ART, it became 3×103 with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8).ConclusionART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.

Hematological and immunological abnormalities among children receiving highly active antiretroviral therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

“…But; our result was lower than the Indian study 65.5% (24). It was also higher than the study done in Addis Abeba, Ethiopia (18.9%) (25). The difference could be due to the difference in the WHO clinical stage, presence of opportunistic infections, nutritional status, population, and geographic difference might some of the factors.…”

“…The prevalence of leukocytosis in our study was (4.8%) which is relatively comparable with the study done in North West Ethiopia (4.1%) (16) but; lower than the study done in Kenya (6.2%) (28). In this study, the prevalence of Neutropenia was (18.3%) which was higher than the study conducted in northwest Ethiopia (15.8%) (26), Bahir Dar, Ethiopia (9.8%) (29), Addis Abeba, Ethiopia (5.7%) (25) and Kenya (16%).The possible difference might be the difference in the immunological status of the study participants and sample size. Neutropenia has been widely reported to be associated with some HAART drugs, particularly combination drugs that included zidovudine.…”

The length of AZT consumption and homocysteine levels are protective factors of macrocytic anemia among adult HIV-infected patients: A case-control study in Central Java Province, Indonesia

“…In total503 subjects were matched with inclusion criteria which were adults (20- 3 Anemia in HIV patients can cause physical and psychological dysfunction, decrease in quality of life, the progressivity of the disease, and decrease in life expectancy. Anemia can happen each year due to HIV infection, and the degree of anemia is related to the progressivity of the disease.…”

“…10,12 Long term ART therapy with AZT was also reported to be associated with bone marrow suppression and mostly can cause anemia. 3,10,13,14 Laboratory findings also proved that AZT causes cytotoxicity in erythroid and myeloid precursor in the bone marrow. 10 The risk of anemia in AZT therapy was reported to be higher compared to other ART such as stavudine and tenofovir.…”

“…2 Studies have shown that 11,7-92% of HIV patients also suffer from anemia. 3 The cause of anemia in HIV patients is presumed to be multifactorial, thus making it challenging to identify the cause of anemia as well as the appropriate treatment. 4 The most important contributing factors in anemia include bone marrow infiltration, use of myelosuppressive drugs, the HIV infection itself, opportunistic infections, or nutrition factors caused by iron, vitamin A, vitamin B12, and folate deficiency.…”