Evaluation of CD4 Count, Haemoglobin, and Intestinal Parasites Status of Cancer Patients Receiving Oncology Therapy in Calabar, Nigeria

Abstract

Cancer is a human cellular error with a high mortality rate, especially in developing regions. Resolving this error with therapy may render patients immunologically depressed and susceptible to opportunistic infections including parasitic. The gut parasites, Cluster of Differentiation four (CD4) cells and haemoglobin (Hb) levels of cancer patients on oncology therapy in Calabar, Nigeria were studied. Stool and blood samples were collected from 317 (186 cancer and 131 apparently healthy) subjects. Parasites were identified using direct smear and formol ether concentration techniques while CD4 and Hb estimation were done using BD-fascount and fluorescent flow cytometric techniques, respectively. Data were analysed using chi-square and independent sample t-test. Overall parasitosis prevalence in this study was (27.44%) with cancer showing an association with intestinal parasitosis (P=0.001) and CD4 level (P=0.002), respectively but none with Hb level. Parasiteinfected cancer subjects had significantly lower mean haemoglobin concentration than their non-infected counterpart (t = - 4.869, P<0.001). Generally, cancer subjects on cancer treatment had an insignificantly lower parasite and significantly lower CD4 levels compared to their non-treated counterpart (P = 0.829) and (P<0.001), respectively but their mean haemoglobin levels were similar (P=0.701). Cancer subjects on chemotherapy alone had significantly higher parasite prevalence, 50.00% compared to 28.95% for those on combined (surgery and chemotherapy) treatment (P=0.014), whereas the type of treatment showed no significant effect on CD4 and Hb levels. Parasite occurrence was only pronounced (71.43%) among subjects with >12 months of treatment duration (P=0.1038). There was a correlation between duration of treatment and CD4 levels (r = - 0.231, P<0.05) but none with haemoglobin levels (r = 0.024, P>0.05) of cancer subjects. In conclusion, although this study has shown that cancer as a condition increases parasite prevalence and reduces mean CD4 counts in subjects, their haemoglobin levels were not significantly affected, except for subjects with intestinal parasite infections. Treatment with cancer therapy did not also affect the haemoglobin concentration, but significantly reduced the CD4 cell number of subjects. Subjects who had majorly, chemotherapy were mostly infected with the parasite but with no noticeable effect on their CD4 and haemoglobin levels. A prolonged duration of treatment increased parasitosis and reduced the CD4 level of subjects but did not affect haemoglobin levels. Apart from the oncological treatments given to cancer subjects, management of cancer subjects should include parasitological examination and treatment, periodic monitoring of their hematologic profile and regular immune revitalization procedures, especially for those placed on prolonged therapy.