Prevalence of Anaemia after Initiation of Antiretroviral Therapy among HIV-infected Patients Attending University of Calabar Teaching Hospital Calabar, Nigeria

Abstract

Aims: To investigating some demographic variables and red cell parameters of infected persons already accessing antiretroviral therapy with a view to identifying sub- groups with higher proportions of anaemia. 
 Study Design: Cross-sectional study.
 Place and Duration of Study: University of Calabar Teaching Hospital Calabar Nigeria, between August 2017 and July 2018.
 Methodology: Subjects comprised 60 male and female HIV-infected adults attending University of Calabar Teaching Hospital Calabar, and equal number of age and sex-matched control subjects who were HIV sero-negative as at the time of this study. The infected persons were being treated with either Tenofovir+Lamivudine+Efavirenz (TLE) or Lamivudine+Zidovudine+Nevirapine (LZN). A pre-tested structured questionnaire was administered by two trained interviewers which captured the bio-data, sociodemographic variables and therapy-related information. Venous blood was collected aseptically by standard phlebotomy into appropriate sample containers for CD4 and red cell counts by automation.
 Results: The proportion of anaemia occurring between TLE and LZN users was observed to be in the ratio of 2:3. The RBC count, haematocrit and haemoglobin concentration were significantly lower (p=.000), while MCV, MCH and RDW were significantly higher (p=.000) in subjects infected with HIV compared to the control subjects, Duration of treatment beyond 6 years significantly raised both MCV (p=.007) and MCH (p=.006) compared to the first 3 years of treatment commencement, while the MCV, MCH and RDW-SD were significantly higher (p=.003, .014 and .018 respectively) among LZN users compared to those on TLE.
 Conclusion: Human immunodeficiency virus infection triggers pathologic mechanisms that culminate into anaemia. While the use of antiretroviral therapy appears to gradually resolve this derangement, the adverse effects of some of the antiretroviral agents contribute to the persistence of anaemia particularly with increasing years of treatment.

Classification of Absolute Cd4+ T Lymphocytes Count in Immunological, Virological and Erythropoietic Growth Factor among HIV Infected Patients

“…This present study revealed correlation between different stages of CD4 count and erythropoietin (EPO) among the study population. In supporting the findings in this study, Okafor reported that HIV has direct effect on the bone marrow through the expression of proinflammatory cytokines that suppress erythropoiesis (Okafor et al, 2019). Anaemia in HIV patients is caused by depressed bone marrow function by HIV infection leading to low production of erythropoietin which resulted into ineffective production of red blood cell (Esan et al, 2020), CD4>500 has higher mean value of EPO compared to CD4 200-499 and CD4<200 in HIV subjects on ART and ART-naïve confirming that the more the severity of HIV infection the lower the erythropoiesis.…”

Effect of Dolutegravir regimen against other regimens on some hematological parameters, CD4 count and viral load of people living with HIV infection in South Eastern Nigeria

“…The lower Hb level in PLWHIV implies anemia and the possible reasons include poor utilization of iron, ineffective erythropoiesis and possible red cell destruction as reported in previous studies. [17,18] Neutropenia is the most common leucopenia occurring in HIV infected individuals. HIV infection on its own suppresses the bone marrow and leads to decreased levels of granulocyte colony-stimulating factor, and also affects the granulocyte-macrophage lineage, thus resulting in leukopenia and neutropenia.…”