The prevalence of HIV seropositivity and associated cytopenias in full blood counts processed at an academic laboratory in Soweto, South Africa.

Abstract

Background. The HIV epidemic in South Africa (SA) has had a substantial impact on laboratory services, at least partially owing to the well-described propensity to cytopenias in HIV-positive patients. Objectives. (i) To formally gauge the impact of HIV infection on the state sector haematology services in SA by determining the HIV seropositivity rate among full blood counts (FBCs) performed at a large academic state sector laboratory; and (ii) to document the prevalence of cytopenias among HIV-positive patients in this setting. Methods. Randomly selected FBCs submitted to the National Health Laboratory Service laboratory at Chris Hani Baragwanath Academic Hospital, Johannesburg, were extracted from the laboratory information system (LIS) and retrospectively reviewed. HIV test results and other pertinent information in the LIS were documented, as was the presence of any cytopenias. Results. HIV status was documented in 561 of 1 006 samples (55.8%), with 307 (54.7%) of these being HIV-positive. Of the HIV-positive patients, 63.2% had one or more cytopenia/s. Anaemia was present in 183/307 (59.6%) of the HIV-positive patients, and was severe (haemoglobin <8 g/dL) in 32/307 (10.4%). Multivariate linear regression analysis showed significant independent associations between the presence of anaemia and both immunological AIDS (iAIDS) (p<0.0001) and male sex (p<0.025), but not HIV viral load (VL) (p=0.33) or antiretroviral therapy (ART) exposure (p=0.70). Thrombocytopenia and neutropenia were present in 37/307 (12.1%) and 11/51 (21.6%) of the HIV-positive patients, respectively, with no statistically significant association between either of these cytopenias and iAIDS, exposure to ART or VL. Conclusions. The findings reflect the substantial impact of the HIV epidemic on state sector laboratory resources, particularly the haematology service.

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.…”

“…Prevalence of cytopenias reported in HIV-infected, treatment-naive cohorts. Scatter dot plot is used to illustrate the percentage ranges reported in 22 (anaemia), [6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30] 8 (thrombocytopenia) [7,8,11,12,[21][22][23][24][25][26] and 6 (neutropenia) [7,8,19,21,22,25,30]…”