Study of haematological abnormalities in HIV infected patients and its correlation with CD4 counts

Abstract

Background: To study and correlate the haematological abnormalities with CD4 cell counts in HIV infected patients diagnosed on OPD basis in S.C.B Medical College, Cuttack, before they are initiated on Antiretroviral (ARV) therapy.Methods: A 100, ELISA positive, untreated HIV patients were included in the study while those patients with history of any haematological disease, Chronic Kidney Disease (CKD), Chronic Liver Disease (CLD), underlying malignancy or on chemotherapy were excluded. Following clinical evaluation, haemoglobin levels (Hb. %), Total Leucocyte Count (TLC), Differential Leucocyte Count (DLC), Erythrocyte Sedimentation Rate (ESR), Platelet Count (PC), CD4 counts (by flow cytometry) and peripheral smear examination was done. They were staged as per WHO clinical staging guidelines given by NACO and statistical analysis was drawn by Fischer Exact Test and association between CD4 counts and haematological abnormalities were inferred.Results: The mean age of the patients was found to be 36.85±6.2 years with males (63%), married (80%) and rural population (78%) showing commonest mode of transmission of the virus as heterosexual route (94%). Most common clinical finding was found to be pallor (68%) with majority in stage III of AIDS. Mean TLC count was found to be 5872±2210 cells/mm 2.40% had leucopenia on TLC and 29% had neutropenia, 30% lymphocytopenia and 20% monocytopenia on DLC. Mean CD4 count was 89 cells per microliter and 79% were anaemic. CD4 counts did not statistically correlate either with WHO staging or cytopenias or haemoglobin levels. However, there was positive association between CD4 counts with anaemia, WHO stages of AIDS, lymphocytopenia and monocytopenia in this study.Conclusions: In this study we could ascertain that, majority were in WHO stage III of AIDS with CD4 counts <200 cells per microliter and blood findings of various cytopenias and anaemia. From our findings, we could correlate between WHO stage of AIDS, CD4 counts and haematological abnormalities thus, establishing the essence of our study.

The global prevalence of thrombocytopenia among HIV-infected adults: A systematic review and meta-analysis

“…In this systematic review and meta-analysis, 20 studies were included and all were used to estimate the pooled prevalence of thrombocytopenia among HIV-infected adults. The lowest and highest prevalence of thrombocytopenia was 3.74% (Mathews et al, 2013) and 41% (Dhal et al, 2018), respectively; both of them were in India. Using random effect analysis, the pooled prevalence of thrombocytopenia among HIV-infected adults was 17.9% (95% CI: 14.69, 21.12).…”

“…International Journal of Infectious Diseases 105 (2021) 495-504 Enawgaw et al, 2014;Taremwa et al, 2015;Gunda et al, 2017;Deressa et al, 2018;Fekene et al, 2018;Katemba et al, 2018;Nka et al, 2019;Tamir et al, 2019;Gebreweld et al, 2020), seven in India (Mathews et al, 2013;Kathuria et al, 2016;Kumar et al, 2016;Dhal et al, 2018;Butale, 2019;Chitra et al, 2019;Patil and Patil, 2020), one in Turkey (HEKIMO GLU et al, 2017), and one in Italy (Franzetti et al, 2014). Of the included studies, nine (45%) were conducted only in treatment-naïve HIV/AIDS patients, eight (40%) were on both treatment and treatment-naïve patients, and three (15%) were conducted only on HIV/AIDS patients having treatment.…”

Baseline Haematological Evaluation in Individuals Prior to Initiating Antiretroviral Therapy for HIV

“…When HIV enters the body, it spreads quickly to cells and tissues, insidiously destroying the lymph node's architecture and prompting the immune system to soar a defense against it via CD4+ and CD8+ T cells, which are then killed by the virus, allowing free HIV replication and eventually full-blown AIDS. The World Health Organization (WHO) has classified AIDS into four stages based on symptoms, clinical signs, and opportunistic infections, starting with Stage I, which is asymptomatic, then Stage II, which is mildly symptomatic, Stage III, which is moderately symptomatic, and Stage IV, which is HIV wasting syndrome 14 .Based on the stage of infection, HIV may have different symptoms. Although persons living with HIV are most infectious in the first few months following infection, many do not feel they are infected until later 15 .…”