Abstract
BackgroundHIV infected children experience a range of hematological complications which show marked improvement within 6 months of initiating anti-retroviral therapy. The Objectives of the study was to describe the changes in hematological indices of HIV-1 infected children following 6 months of treatment with first line antiretroviral drugs (ARVs) regimen.MethodsA retrospective study was conducted between September and November 2008. During this period medical records of children attending Comprehensive Care Clinic at Kenyatta National hospital were reviewed daily. HIV infected children aged 5–144 months were enrolled if they had received antiretroviral drugs for at least 6 months with available and complete laboratory results.ResultsMedical records of 337 children meeting enrollment criteria were included in the study. The median age was 63 months with equal male to female ratio. Following 6 months of HAART, prevalence of anemia (Hemoglobin (Hb) <10 g/dl) declined significantly from 35.9 to 16.6 % a nearly 50 % reduction in the risk of anemia RR = 0.56 [(95 % CI 0.44, 0.70) p < 0.001]. There was significant increase in Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and platelets above the baseline measurements (p < 0.0001) and a significant decline in total white blood cell counts >11,000 cell/mm3 but a none significant decrease in red blood cells (RBC). Pre-HAART, World Health Organization (WHO) stage 3 and 4 was associated with a ten-fold increased likelihood of anemia. Chronic malnutrition was associated with anemia but not wasting and immunologic staging of disease.ConclusionHematological abnormalities changed significantly within 6 months of antiretroviral therapy with significant increase in hemoglobin level, MCV, MCH and platelet and decrease in WBC and RBC.
Highlights
human deficiency virus infection (HIV) infected children experience a range of hematological complications which show marked improvement within 6 months of initiating anti-retroviral therapy
The objective of the study was to describe the changes in hemoglobin levels, red cell morphology, white blood cells and platelets in HIV-1 infected children aged 5–144 months following 6 months of highly active antiretroviral therapy at the comprehensive care clinic of Kenyatta National Hospital (KNH)
Baseline characteristics of the study participants A total of 337 children were recruited into the study, among them 53.4 % female and 46.6 % male giving a female to male ratio of 1.1:1, and a median age of 63 months as shown in the Table 1
Summary
HIV infected children experience a range of hematological complications which show marked improvement within 6 months of initiating anti-retroviral therapy. Hematological complications of human deficiency virus infection (HIV) which include cytopenias of all major cell lines were recognized shortly after the first description of AIDS cases [1]. In a meta-analysis of over 2000 HIV infected children, the prevalence of mild [hemoglobin (Hb) 10–12.0] and moderate anemia (Hb 8.0–9.9) was 22–94 % and 3–82 % respectively [10]. Neutropenia is present in approximately 10 % of patients with early, asymptomatic HIV infection, and more than half in individuals with more advanced HIVrelated immunodeficiency [5, 6, 11]. Thrombocytopenia which is frequently asymptomatic occurs in 20 % to 33 % of paediatric patients with HIV with the prevalence increasing with duration of illness and development of Aids [5, 6, 9, 11, 12]
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