Abstract
BackgroundAnemia is the most common hematological abnormality in Human immunodeficiency virus (HIV) positive patients and a significant predictor of its progression to AIDS or death. This study was aimed to assess the prevalence of anemia before and after initiation of antiretroviral therapy (ART) among HIV positive patients attending Black Lion Specialized Hospital, Addis Ababa, Ethiopia.MethodsA cross sectional study was conducted from January to April, 2017 in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. A total of 255 patients on ART were selected using simple random sampling techniques. Socio-demographic and clinical characteristics of the study subjects were collected using structured questionnaire. Measurements of complete blood cell counts and CD4 + T cell counts were made using Sysmex XT 2000i hematology analyzer and BD FACS Count CD4 analyzer, respectively. Statistical analysis of the data (Chi-square, paired T-test, logistic regression) was done using SPSS version 20. A p-value < 0.05 was considered as significant.ResultsPrevalence of anemia before and after ART initiation was 41.9 and 11.4% respectively. There are a significance differences in CD4 + T cell count, RBC count, hemoglobin values and RBC indices in HIV patients before and after ART initiation (p-value < 0.05). WHO clinical stages and CD4+ T cell counts were found to be associated with the prevalence of anemia before ART initiation. Among the total number of anemic cases, normocytic normochromic anemia was present in 71% of the cases before ART and in 58.6% of the cases after ART. The prevalence of macrocytic normochromic anemia before and after ART initiation was 4.7 and 27.6% respectively.ConclusionsIt is evident from this study that there is a remarkable reduction in the prevalence of anemia after ART initiation. However, a significant proportion of HIV patients remained anemic after 6 months of ART initiation suggesting the need for routine screening and proper treatment of anemia to mitigate its adverse effects.
Highlights
Anemia is the most common hematological abnormality in Human immunodeficiency virus (HIV) positive patients and a significant predictor of its progression to acquired immunodeficiency syndrome (AIDS) or death
Patients after antiretroviral therapy (ART) initiation have high hemoglobin level, Mean cell volume (MCV), Mean cell hemoglobin (MCH), Mean cell hemoglobin concentration (MCHC) and Cluster of differentiation 4 (CD4)+ T cell counts when compared to ART naïve patients (p < 0.001) (Table 2)
There was a remarkable reduction in the prevalence of anemia after ART initiation
Summary
Anemia is the most common hematological abnormality in Human immunodeficiency virus (HIV) positive patients and a significant predictor of its progression to AIDS or death. The frequency and severity of these hematological manifestations increased with the decline in CD4 counts [3] with anemia being the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival [4]. Other common causes of anemia in AIDS are anemia of chronic disease, bone marrow suppression by ART, and hemolytic anemia induced by oxidant drugs [6, 7]. Cytokines such as interleukin 1, tumor necrosis factor and the interferon play a role in impairing erythropoietin response by reducing concentration of marrow progenitors and erythroid colonies. Commonly used myelosuppressive drugs in the HIV setting may contribute to anemia and even in the era of ART, anemia continues to contribute to morbidity and diminished quality of life [8]
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