Hematological abnormalities in HIV-antiretroviral therapy naïve clients as seen at an immune suppression syndrome clinic at Mbarara Regional Referral Hospital, southwestern Uganda

Abstract

Aim/objectiveTo assess the common hematological abnormalities among HIV-antiretroviral therapy (ART) naïve clients attending an immune suppression syndrome (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.Patients and methodsThis was a cross-sectional study carried out during the months of March to August 2016 at the ISS clinic of MRRH. We collected approximately 4.0 mL of EDTA anticoagulated blood samples, which were assayed for complete blood count, CD4+ cell count and thin film examination. Correlation of the hematological abnormalities with CD4+ cell counts was done using correlation coefficient (r) and analysis of variance (F), and the p-value was set at ≤0.05.ResultsA total of 141 clients were enrolled. Of these, 67.38% (95/141) were anemic, 26.24% (40/141) had thrombocytopenia while 26.95% (38/141) had leucopenia. Of the 95 participants with anemia, 89.47% (85/95) presented with normocytic-normochromic anemia, 8.42% (8/95) with microcytic-hypochromic anemia and 2.11% (2/95) with macrocytic-hypochromic anemia. Anemia was not different across the several World Health Organization (WHO) stages of HIV infection disease progression (p>0.05). Statistically significant differences were present among participants with leucopenia (p<0.05). Also, leucopenia was more prevalent (11/38) among participants in WHO stage 4 of HIV infection. CD4+ cell counts correlated with thrombocytopenia (r=0.24, p<0.05) and leucopenia (r=0.15, p<0.05).ConclusionPeople living with HIV/AIDS (PLWHIV/AIDS) ought to be routinely monitored and treated for the occurrence of hematological abnormalities. Early initiation of ART can help to prevent some hematological abnormalities.

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.…”

“…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.…”

“…3) in the treatment-naïve cohorts studied. [7,8,11,12,[21][22][23][24][25][26] Although the prevalence and severity of thrombocytopenia is associated with disease stage, the relationship is not always linear as newly infected patients with HIV may also present with thrombocytopenia. [4] Thrombocytopenia is also more frequently…”

“…3) of treatment-naïve patients studied. [7,8,[19][20][21][22]25,30] The wide range of frequencies reported for HIV-associated neutropenia is likely to be associated with the severity of HIV disease and the use of prophylactic drugs, such as cotrimoxazole, which is known to cause bone marrow suppression through the inhibition of folic acid metabolism. A low CD4 T cell count and high HIV plasma viral load are risk factors for developing neutropenia.…”

“…2). [13,23,25] In addition, neutropenia severity is related to risk of opportunistic co-infection, with a count below 1 ×10 9 neutrophils/L indicating a significantly increased risk. [4] Benign, ethnic neutropenia has a high prevalence in individuals of African descent.…”