Abstract
BackgroundHematologic abnormalities involving peripheral blood cell cytopenias are strong predictors of morbidity, mortality and poor antiretroviral therapy (ART) outcomes of HIV infected individuals. However, limited studies are conducted in resource-limited settings of sub-Saharan Africa that have addressed the magnitude and associated factors of cytopenias. This study aimed to investigate the magnitude and associated factors of cytopenias among ART naïve HIV infected adult Ethiopians.Materials and methodsA cross-sectional study was conducted among ART naïve HIV infected individuals attending at ART unit of Dessie Referral Hospital between November 01, 2015 and April 30, 2016. A total of 402 adults were included using consecutive sampling. Socio-demographic, clinical and laboratory data of patients were collected. The data were entered to Epi Info version 3.4.3 and analyzed using SPSS version 20 software (SPSS INC, Chicago, IL, USA). Factors associated with cytopenias were analyzed first using bivariate and then multivariate logistic regression models. An odds ratio with 95% confidence interval was used to measure the strength of association. For all statistical significant tests, the cut-off value was set at P<0.05.ResultsIn this study, the overall magnitude of any cytopenia, anemia, leucopenia and thrombocytopenia were 63.4%, 43.5%, 24.4% and 18.7%, respectively. In multivariate logistic regression analysis, severe immunosuppression and WHO clinical stage IV HIV disease were significantly associated with increased prevalence of cytopenias. In addition, older age and younger age showed significant association with increased prevalence of anemia and leucopenia, respectively.ConclusionFrequent occurrence of cytopenias was independently associated with severe immunosuppression and WHO clinical stage IV HIV disease. Further longitudinal multicenter studies are recommended to bolster the findings of this study in order to suggest the need of routine assessment and management of hematological abnormalities for optimal choice of initial antiretroviral agents and prevention of further morbidities.
Highlights
Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) encompass a clinical spectrum of diseases in which cytopenias of all blood cell lines are encountered especially in antiretroviral therapy (ART) naïve patients [1, 2]
In multivariate logistic regression analysis, severe immunosuppression and World Health Organization (WHO) clinical stage IV HIV disease were significantly associated with increased prevalence of cytopenias
Further longitudinal multicenter studies are recommended to bolster the findings of this study in order to suggest the need of routine assessment and management of hematological abnormalities for optimal choice of initial antiretroviral agents and prevention of further morbidities
Summary
Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) encompass a clinical spectrum of diseases in which cytopenias of all blood cell lines are encountered especially in ART naïve patients [1, 2]. Cytopenias including anemia, leucopenia and thrombocytopenia are among the most common non immunological complications of HIV infection [3, 4]. A systematic review of the literature documented the prevalence or incidence of anemia in HIV-infected patients ranges from 1.3% to 95% depending on the stage of HIV/AIDS disease and definition of anemia, making it more common than thrombocytopenia or leucopenia in HIV/AIDS patients [10, 11].
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