Neutropenia in Human Immunodeficiency Virus Infection: Data From the Women's Interagency HIV Study

Abstract

Background: Neutropenia is well described in individuals infected with human immunodeficiency virus (HIV) and occurs in approximately 10% to 50% of cases. Neither the effect of highly active antiretroviral therapy (HAART) on neutrophil counts nor the significance of neutropenia in terms of survival has previously been evaluated.Methods: The prevalence of neutropenia among 1729 HIV-infected women, followed up as part of the Women's Interagency HIV Study, was evaluated. The CD4 lymphocyte counts, HIV-1 RNA levels, and complete blood cell counts, including absolute neutrophil counts, were obtained at 6-month intervals.Results: Neutropenia was common among HIVinfected women; at baseline, 44% had neutrophil counts less than 2000/µL, whereas 7% had counts less than 1000/ µL. During 7.5 years of follow-up, neutrophil counts less than 2000/µL occurred on at least 1 occasion in 79%, whereas absolute neutrophil counts less than 1000/µL were documented in 31%. Worsening HIV disease parameters, such as lower CD4 cell counts (PϽ.001) and higher HIV-1 RNA levels (PϽ.001), were associated with development of neutropenia. Resolution of neutropenia was associated with higher CD4 cell counts (PϽ.001) and use of HAART (P=.007). We found that HAART, without zidovudine, was associated with protection against development of neutropenia. On multivariate analysis, neutropenia was not found to be associated with decreased survival among HIV-infected women.Conclusions: Worsening HIV disease parameters are associated with neutropenia in HIV-infected women. Treatment with HAART, without zidovudine in the regimen, protects against development of neutropenia, whereas HAART use and higher CD4 cell counts are associated with resolution of neutropenia. Neutropenia is not associated with decreased survival in HIV-infected women.

The Duffy-null state is associated with a survival advantage in leukopenic HIV-infected persons of African ancestry

“…10 We now show that this association is evident mainly in those AAs who maintained a low WBC count during disease, suggesting that the genotype-phenotype relationships for the DARC-null state are highly dependent on the cellular milieu. These findings may also help explain the observation that neutropenia, which is found commonly in HIV-infected patients, 2,3 was not associated with decreased survival in a large study of HIV-infected African American women. 2 The basis for the association between DARC Ϫ46C/C and survival advantage during HIV disease remains unknown, but we offer the following possible explanations.…”

“…These findings may also help explain the observation that neutropenia, which is found commonly in HIV-infected patients, 2,3 was not associated with decreased survival in a large study of HIV-infected African American women. 2 The basis for the association between DARC Ϫ46C/C and survival advantage during HIV disease remains unknown, but we offer the following possible explanations. First, it can be argued that the association of DARC Ϫ46C/C with survival advantage in leukopenic HIV ϩ AAs represents a tautology.…”

“…[1][2][3] For example, evaluation of a large number of incarcerated adults revealed that leukopenia correlated strongly with HIV seropositivity, independent of other variables, such as sex with an HIV-positive (HIV ϩ ) partner, injection drug use, ethnicity, and presence of sexually transmitted diseases. 4,5 Interestingly, in these studies, the risk for HIV seropositivity associated with leukopenia and a history of sex with an HIV ϩ partner were similarly high, 4 underscoring that leukopenia is strongly associated with HIV positivity in at-risk persons and is commonly observed soon after HIV infection.…”

“…1,8 By contrast, there are no prospective studies in natural history cohorts that have examined whether leukopenia impacts on HIV disease course, independent of the known strong relationship between immunodeficiency (reflected by low CD4 ϩ counts or high viral loads) and either leukopenia or neutropenia. 1,2,9 To address this, we determined whether leukopenia impacts on the HIV disease course of subjects in a natural history cohort. [10][11][12][13] The large representation of both European Americans (EAs) and African Americans (AAs) in the study population allowed us to examine whether the impact of leukopenia on disease course differed according to race.…”

Spinal Epidural Aspergillosis in a Patient With HIV Resulting From Long-Standing (3 Years) Lung Infection

“…2 However, studies have shown a direct relationship between severe HIV infection and neutropenia. 1,5 Other possible explanations for infection in patients with HIV disease include the increasing use of corticosteroid treatment, as is used in the treatment of Pneumocystis carinii pneumonia 1,6,7 ; neutropenia-inducing antiretroviral drugs such as zidovudine 1,6 ; and a prolonged life of patients with late-stage HIV disease. 1,6,7 We find 3 interesting features of this case.…”