Abstract
Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 μL, white cell count <4000 μL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student’s t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders.
Highlights
Hematological abnormalities are frequently observed in patients with HIV infection
The purpose of this study was to determine the prevalence of pancytopenia at enrollment in a cohort of HIV-infected Hispanics followed at the Retrovirus Research Center (RRC) in Bayamón, Puerto
Leucopenia and thrombocytopenia have been described at a lesser extent, and the concurrent observation of the three, pancytopenia, is the least investigated (a PubMed search conducted on August 10, 2015 retrieved 2892 results for anemia, 1202 for thrombocytopenia, 928 for leucopenia and 188 for pancytopenia)
Summary
Cytopenias, are the most common of these disorders [1,2]. It has been described that cytopenias, including anemia, leucopenia, and thrombocytopenia, are multifactorial in nature and are associated to an advanced HIV stage, the presence of a high viral load, the use of antiretroviral treatment (ART), the presence of acute and chronic opportunistic infections and infiltrative conditions [1,3,4,5]. The occurrence of universal cytopenia, known as pancytopenia, is usually seen in late stages of HIV infection [5,6]. The presence of isolated cytopenias, and, to a larger degree, pancytopenia, has been associated to a complex spectrum of medical conditions and frequently conveys decreased survival [1,2]. Many studies have described pancytopenia in the context of HIV [2,5,6,7,8,9,10,11]; few studies have evaluated the association of pancytopenia with the sociodemographic profile of subjects, the role of HIV risk practices, the impact of therapeutic interventions, and prognosis
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