Anaemia In HIV-infected Children Research Articles

Factors Related To Incidence of Anemia in HIV Infected Children With Zidovudin in H Adam Malik Hospital

Background: Anemia is one of the most common haematological complications in people with HIV infection. Anemia is associated with increased disease progression as well as worsening clinical conditions. Zidovudin is the first-line anti-retoviral treatment of HIV which has anemia side effects. The prevalence of anemia due to zidovudine varies from 3.7% to 41.6%, 21.3% was moderate-severe anemia. Besides zidovudin, there was a relationship between age, CD4 cell count, and opportunistic infections with the incidence of anemia. Objective: To study factors related to incidence of anemia in HIV infected children with zidovudin in H Adam Malik general hospital. Methods: A retrospective cross-sectional study, 80 subjects who received zidovudin therapy were taken through medical records, then analyzed bivariate and multivariate analysis of risk factors for anemia. Results: The incidence of anemia was 41.4% consisting of mild anemia 28.6%, moderate anemia 5.7%, severe anemia 7.1%. There is a correlation between anemia and immunodiciency status (P <0.001, PR 12.833, CI 1.863 - 88.395), nutritional status (P <0.001, PR: 10.731, CI 2.763 - 41.671), and length of therapy (P = 0.001, PR 2.779, CI 1.428 - 5,409). Multivariate analysis found that nutritional status was the most influential risk factor in influencing the onset of anemia in children with HIV who were given zidovudine therapy. Conclusion: there is a relationship between nutritional status, immonodeficiency status and length of therapy to the incidence of anemia in HIV-infected children who are given zidovudine therapy.

Anaemia in HIV-Infected Children in A National Referral Hospital in Uganda: Prevalence and Associated Factors

Anaemia in HIV-Infected Children in A National Referral Hospital in Uganda: Prevalence and Associated Factors

To study the incidence of anemia in HIV-infected children on zidovudine-based highly active antiretroviral therapy regimen.

To study the incidence of anemia in HIV-infected children on zidovudine-based highly active antiretroviral therapy regimen.

Etiological structure of anemia in HIV-infected children

In most cases, HIV infection in children is accompanied by the development of anemia with a decrease in hemoglobin levels. We studied the structure of anemia in 114 children with HIV infection aged from 1 year to 18 years. Depending on the clinical stage of HIV infection, the patients were divided into 3 groups: 1st group — 20 children with the second clinical stage of HIV infection; 2nd group — 74 children with the third clinical stage; 3rd group — 20 children with a fourth clinical stage. Serum iron and ferritin were determined. In the majority of patients (95.2%) of the studied groups iron deficiency anemia (IDA) was detected, in 4.8% of cases anemia of chronic diseases (ACD) was detected. The importance of differentiation of the identified anemia determines the therapeutic tactics and the need for the appointment of iron-containing drugs.

Malaria infection and anaemia in HIV-infected children in Mutengene, Southwest Cameroon: a cross sectional study.

BackgroundMalaria is one of the leading causes of morbidity and mortality in children and HIV infection as well as other factors may worsen the situation. This study was aimed at determining the factors influencing malaria parasite prevalence and density as well as anaemia in HIV-infected children in Mutengene, Cameroon from November, 2012 to April, 2013.MethodsA semi-structured questionnaire was used to record information on socio-demographic factors and use of preventive measures by caregivers of HIV-infected children aged 1–15 years and of both sexes. Venous blood was collected; blood films were prepared and Giemsa-stained for parasite detection and speciation. Haemoglobin concentration was measured and the anaemic status determined. Data was analysed using Epi Info 7 software.ResultsA total of 234 children were studied. The overall malaria parasite prevalence was 24.8 % (58) and was significantly higher (31.9 %, P = 0 .004) in females, those who did not implement any preventive measure at all (66.7 %, P = 0.03) and children who used antiretroviral therapy (ART) (28.6 %, P = 0.02) when compared with their respective counterparts. Geometric mean parasite density (GMPD) was significantly higher (3098.4, P = 0.02) in children who presented with fever, had CD4 T cells ≥500 cells/μL (491.3, P = 0.003) and those with moderate anaemia (1658.8, P = 0.03) than their respective counterparts. Although there was no significant difference, GMPD was however higher in males (549.0); those not on ART (635.0) and highest in children <5 years old (633.0) than their respective counterparts. The overall prevalence of anaemia was 49.6 % (116). The value was significantly highest (58.3 %, P = 0.01) in the 11–15 years age group; those with CD4 T cell level 200–499 (72.7 %, P = 0.001) and children with fever (85.7 %, P = 0.01).ConclusionImplementation of proper and integrated malaria preventive measures as well as frequent monitoring of anaemia on prescription of ART could likely improve the health conditions of HIV-infected children thus avoiding malaria-related morbidity and mortality.

Zidovudine-Induced Anaemia in Human Immunodeficiency Virus Infected Children on Highly Active Anti-Retroviral Therapy in Jos, Nigeria

Aims: To determine the incidence and severity of zidovudine -induced anaemia in HIVinfected children initiated on anti -retroviral therapy in Jos, Nigeria. Study Design: This was an observational cohort study. OriginalResearch Article

Evaluating Biomarkers Of Iron Deficiency Anemia In Anemia Of Inflammation

IntroductionLow middle income countries like India have a high prevalence of childhood anemia (74% in children <5years of age) (NFHS-3 survey 2006) and the predominant cause is iron deficiency anemia (IDA) (Pasricha et al, Pediatrics 2010). Additionally, in this setting there is a large burden of infectious diseases in children. Thus, several community dwelling Indian children have anemia and infection, where the use of standard markers such as ferritin to diagnose IDA is challenging. Using HIV infected children as a model for anemia of inflammation (AI), we explored the utility of zinc protoporphyrin/heme (ZPP/H) as a biomarker for the diagnosis of IDA superimposed on AI. MethodsWe prospectively enrolled 241 HIV-infected children in a multicentric study to assess anemia in HIV infected children. Of these, 221 children (aged 2-12 years, mean 7.86 years) had evaluable blood samples that were used to measure hematological and biochemical parameters. Stored samples of washed erythrocytes were used to measure Zinc protoporphyrin/Heme ratio (ZPP/H) with a hematofluorometer (AVIV Biomedical). Using standard biochemical assays, we measured serum ferritin, high sensitivity C-reactive protein and serum transferrin receptor levels. Anemia was defined using WHO age specific hemoglobin-based criteria (2011). The soluble transferrin receptor log ferritin index (sTfR-F index ≥1.5) was used to identify those having pure IDA (index ≥ 1.5) and non-iron deficient AI (sTfR-F index < 1.5). Statistical analysis was performed using SPSS software (version 21.0 for Mac). The performance of ZPP/H ratio was compared to sTfR-F index as a gold standard using Receiver Operator Characteristics (ROC). ResultsAmong 221 evaluable patients, the mean age was 7.9 ± 2.5 years with a range of 2-12 years. Based on an age-stratified hemoglobin criteria (WHO, 2011), 65 children (29.4%) were classified as anemic, of whom 56% were males. Comparisons between anemic and non-anemic children are presented in tables 1 and 2. Using previously published biochemical criteria (sTfR index > 1.5; Punnonen et al, Blood 1997); we found that the sTfR index detected pure IDA in 43% cases. Using an alternative algorithm based on the serum ferritin value (Goodnough et al, NEJM 2005), the patients were reclassified into pure IDA (46.2%, <30mg/l), pure AI (20.0%, >100mg/l) and mixed IDA and AI (33.8%, 30-100mg/l). High sensitivity CRP (>1.0mg/dl indicating inflammation) biochemically defined AI, in 35.4% patients. An ROC for ZPP/H levels was plotted using the sTfR index as a gold standard (n=65), with an area under the curve (AUC) of 0.80 and a standard error of 0.05. The ZPP/H cutoff value of 59.5μmol/mol heme, on the efficiency curve, identified IDA with 96.4% sensitivity and 78.4% specificity. ConclusionOur studies suggest that a ZPP/H cutoff value of 59.5 μmol/mol heme can diagnose IDA in anemic HIV infected children with acceptable sensitivity and specificity. In low middle-income countries, ZPP/H is a relatively cost efficient point of care test that can guide the use of iron supplements. However, further studies in a healthy pediatric population are needed to assess the validity of these cut off values. Disclosures:No relevant conflicts of interest to declare.

Anaemia in HIV-infected children: severity, types and effect on response to HAART

BackgroundHIV and anaemia are major health challenges in Africa. Anaemia in HIV-infected individuals is associated with more rapid disease progression and a poorer prognosis if not addressed appropriately. This study aimed at determining the severity and types of anaemia among HIV infected children and its effect on short term response to antiretroviral therapy (ART).MethodsAt baseline, clinical and haematological parameters of 257 HIV-infected ART-naïve children aged 3 months to 18 years were assessed to determine the prevalence, severity and types of anaemia. ART eligible patients were started on therapy according to WHO criteria, enrolled (n=88) into an observational cohort and followed up for 6 months.ResultsAnaemia was present in 148/257 (57.6%) of children, including (93/148) 62.2% with mild anaemia, 47/148 (32.0%) moderate anaemia, and 7/148 (4.8%) with severe anaemia. The mean haemoglobin (hb) was lower among children with more advanced HIV disease (p<0.0001). Microcytic-hypochromic anaemia (44.9%) was the commonest type of anaemia. Anaemia was independently associated with young age (p <0.0001), advanced HIV WHO disease stage (p = 0.034) and low CD4 percentage (p = 0.048). The proportion of children who had attained viral suppression (viral load <400 copies/ml) at 3 months was significantly lower among the anaemic children, 31/58 (53.4%) compared to the non-anaemic children 26/30 (86.7%) (p=0.002). However, the difference in clinical and immunological response between the anaemic and non-anaemic patients did not reach statistical significance.ConclusionAnaemia is highly prevalent among HIV-infected children in a rural Ugandan clinic and is associated with poorer virological suppression. However, the anaemia did not impact clinical and immunological response to ART among these children.

Risk factors for anaemia among HIV infected children attending care and treatment clinic at Muhimbili National Hospital in Dar es Salaam, Tanzania

There is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic regression analyses were performed to identify possible factors associated with anaemia in HIV-infected children. &nbsp;A total of 75 (44%) patients among 167 recruited HIV-infected children aged 6 months to 59 months of &nbsp;were found to be anaemic (Hg&lt;11g/dl). Multivariate logistic regression demonstrated that not being on HAART (OR 3.40, 95%CI (1.20-9.60), having CD4% &lt;25% (OR 2.30, 95%CI (1.20-34.60), having a history of tuberculosis (TB) (OR 3.23, 95%CI (1.10-9.70) and having hookworm infestation (OR 5.97, 95%CI (1.92-18.4) were independent risk factors for anaemia among HIV infected children. The analyses also showed that being HIV positive for &ge; 2.5 years resulted into a low risk of severe anaemia compared to being HIV positive for &lt; 2.5 years. Taking multivitamins (OR 0.07, 95%, CI (0.020-0.30) and antihelminthics (OR 0.27, 95%CI (0.10-0.74) were also protective against anaemia in children. Similar factors (with exception of using antihelmintics) were associated with severe anaemia. In conclusion the factors associated with anaemia in HIV infected children were multifactorial in nature. Efforts to correct anaemia in HIV infected children should include use of HAART and treatment of infections such as TB and hookworms.

The burden and morhological types of anaemia among HIV infected children in Dar es salaam,Tanzania

Background: There is paucity of data describing magnitude of anaemia among HIV infected children in Tanzania. Most of the studies among anaemic Tanzanian children were conducted before the era of HIV and HAART.Materials and Methods: This was a cross sectional study aimed at determining the prevalence and morphological types of anaemia among HIV-infected children attending public hospitals in Dar es Salaam. The prevalence of anaemia was determined as a percentage among all children infected with HIV. To describe the spectrum of red blood cell (RBC) morphology on blood films a pairwise comparison was conducted using Chi squire test or Fisher&rsquo;s exact test.Findings: In this study the overall prevalence of anaemia (Hb&lt;11g/dl) among 167 HIV infected children attending public hospitals was 44%. Among enrolled children, 35 (21.1%) had mild anaemia, 14(8.4%) had moderate anaemia and 26(15.6%) had severe anaemia. Microcytic anaemia was found to be the commonest (73%) type of anaemia followed by normocytic normochromic anaemia. The abnormal red blood cell shape (P=0.02), microcytosis (P&lt;0.001), hypochromia (P&lt;0.001), and abnormal platelet morphology (P&lt;0.001), were common in anaemic HIV infected children compared to those who had no anaemiaConclusions and recommendations: The finding suggests that anaemia is common among HIV children even in the era of HAART. Microcytic hypochromic anaemia was the commonest type of anaemia suggesting the role of iron deficiency or anaemia of chronic infection. Further studies on the aetiology of anaemia in HIV infected children are neededKey words: HIV, Severel Aaemia Child

The prevalence and etiology of anemia among HIV-infected children in India

In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2-12 years were prospectively enrolled in 2007-2008. Measured parameters included serum ferritin, vitamin B(12), red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B(12) deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18-26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score -2.5 vs. -1.9), stunted (height Z-score -2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p < 0.01), and higher log viral load (11.1 vs. 7.1, p < 0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p = 0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p < 0.01). Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.

Prevalence of Anaemia in HIV-Infected Children at the University of Abuja Teaching Hospital, Gwagwalada

Use of highly active antiretroviral therapy (HAART) has remained the only regimen potent enough to reduce viral replication in HIV-infected individuals. Its combination with cotrimoxazole has also been recommended in those with CD4% of less than 15%. The use of HAART containing zidovudine (ZDV) in combination with co-trimoxazole carries the risk of anaemia in already anaemic predisposed individuals from HIV infections, opportunistic infections, parasitic infestations, sickle cell anaemia, and malnutrition. The aim of the study is to document the effect of use of combination of HAART containing ZDV with cotrimoxazole in haemoglobin profile of HIV-infected children after one year of its administration at the University of Abuja Teaching Hospital (UATH), Gwagwalada. It is also aimed at comparing the result obtained with those on stavudine containing HAART with co-trimoxazole. A two year prospective study of HIV-infected children on treatment with HAART in combination with co-trimoxazole, and attending the paediatric outpatient special treatment clinic (POSTC) for HIV infected children at the UATH, Gwagwalada from November 2006 to October 2008, was carried out to determine effect of these drug combinations in the haemoglobin profile of infected children. Three monthly PCV level was carried out using haematocrit centrifuge and reader. A total of 173 patients were started on HAART during the first year recruitment period, 90 (52.0%) were males, while 83 (48.0%) females, giving a male to female ratio of 1.1:1. One hundred and seventeen (67.7%) of patients were on ZDV containing HAART, while 56 (32.3%) were on stavudine containing combination. All patients were started on co-trimoxazole prophylaxis with the exception of 6 (3.5%) patients because of drug reaction. The mean PCV of patients on ZDV containing combination with cotrimoxazole decreased from 30.2 +/- 5.5% to 29.0 +/- 2.3%, with a net decrease of 1.2% after one year treatment, those on stavudine containing combination with co-trimoxazole instead showed an increased from initial PCVof 28.3 +/- 4.2% to 34.2 +/- 3.0% with a net increase of 5.9% after the same duration of treatment, (p > 0.05). While patients on ZDV combination alone without co-trimoxazole prophylaxis had a minimal decrease of 0.9% in their PCV level after one year treatment, those on stavudine combination alone without any prophylaxis instead showed an increase of 6.8% in their PCV after the same duration of treatment. A combination of HAART containing ZDV plus co-trimoxazole carries risk of anaemia than that of stavudine containing combination with co-trimoxazole. Such combination should therefore not be given to anaemic patients. Regular check in PCV of patients on HAART combination with ZDV and additional cotrimoxazole prophylaxis is required for early detection of significant drop in PCV level.

Iron supplementation for reducing morbidity and mortality in children with HIV

The most prevalent haematologic disturbance associated with HIV in children (apart from CD4 lymphocytopenia) is anaemia. Anaemia associated with HIV arises from multiple mechanisms, including the direct inhibitory effect of HIV on red cell precursors, other locally prevalent and/or opportunistic infections, micronutrient deficiency, anaemia of chronic disease, and as a consequence of medicines given for HIV and/or other concurrent illnesses. Iron deficiency is the most common cause of nutritional anaemia globally. There is significant geographical overlap of areas of the world where iron deficiency anaemia (IDA) and paediatric HIV are distributed. Given the high prevalence of IDA, it is likely that many HIV-infected children also are iron deficient. The contribution of iron deficiency to anaemia in HIV-infected children has been described but is incompletely understood. Currently, iron supplementation for anaemic infants and children is routinely practiced without any obvious effect in most developing countries, which bear most of the burden of global paediatric HIV infections.Because iron deficiency and IDA are common in HIV-infected children in high-prevalence areas and because there are concerns about possible deleterious effects of iron, this review aims to assess the evidence for iron supplementation for reducing morbidity and mortality in HIV-infected children. To determine whether iron supplementation improves clinical, immunologic, and virologic outcomes in children infected with HIV SEARCH STRATEGY: We used the comprehensive search strategy developed specifically by the Cochrane HIV/AIDS Review Group to identify HIV/AIDS randomised controlled trials, and searched the following electronic databases: MEDLINE (searched November 2007); Embase (searched December 2007); and CENTRAL (December 2007). This search was supplemented with a search of AIDSearch (searched December 2007) and NLM Gateway (searched December 2007) to identify relevant conference abstracts, as well as a search of the reference lists of all eligible articles. The search was not limited by language or publication status. Randomised controlled trials (RCTs) of iron supplementation in any form and dose in HIV-infected children aged 12 years and younger. We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria. No RCTs of iron supplementation in HIV-infected children were found. The current clinical practice of iron supplementation in HIV-infected children is based on weak evidence comprising observational studies and expert opinions. High-quality RCTs of iron supplementation are urgently required, especially in areas with significant overlap of high prevalence of HIV, iron deficiency anaemia, and malaria. Policy makers should prioritise funding for these trials.

HIV-associated anemia in children: a systematic review from a global perspective

To assess the importance of anemia in HIV-infected children in western and tropical settings. A systematic review with a descriptive component. : Four databases were searched and reference lists of pertinent articles were checked. Studies that reported data on anemia or hemoglobin levels in HIV-infected children were selected and grouped according to the location and the definition of anemia. Thirty-six studies met the inclusion criteria. Mild (hemoglobin <11 g/dl) and moderate (hemoglobin <9 g/dl) anemia were more prevalent with HIV infection (odds ratio 4.5; 95% confidence interval 2.5-8.3 and odds ratio 4.5; 95% confidence interval 2.0-10.3, respectively). Mean hemoglobin levels were lower (standardized mean difference; 0.79; 95% confidence interval 0.47-1.10). These differences were observed in both western and tropical settings. Anemia incidence ranged from 0.41 to 0.44 per person-year. There was limited data on more severe anemia (hemoglobin <7 or <5 g/dl). As anemia was frequently identified as an independent risk factor for disease progression and death, we next reviewed the limited data to formulate better strategies. Failure of erythropoiesis was the most important mechanism for anemia in HIV-infected children. Therapeutic options include highly active antiretroviral therapy and prevention or treatment of secondary infections. Erythropoietin can improve anemia in children, but it has not been evaluated in developing countries. Micronutrient supplementation may be helpful in individual children. The potential benefits or risks of iron supplementation in HIV-infected children require evaluation. Anemia is a very common complication of pediatric HIV infection, associated with a poor prognosis. With the increasing global availability of highly active antiretroviral therapy, more data on the safety and efficacy of possible interventions in children are urgently needed.

Recombinant erythropoietin for treatment of anaemia in HIV-infected children

Recombinant erythropoietin for treatment of anaemia in HIV-infected children

Prevalence of anaemia in paediatric patients with HIV infection in Kano

Background: HIV infection affects virtually all systems of the body including the haematological system.Objective: To determine the prevalence of anaemia in HIV infected children and compare with apparently healthy HIV negative age-sex matched controls.Design: Case control hospitalbased study.Methods: A total of 60 confirmed HIV infected antiretroviral naïve children and 60 HIV negative children were enrolled in a case control study of baseline haematological indices. In all cases, haemoglobin, total white blood cell count, neutrophils, lymphocytes and platelet counts were determined using SYSMEX XT- 2000i Haematologic auto-analyser. Children with HIV/AIDS were classified according to clinical disease stages using the 2006 World Health Organization (WHO) staging criteria. Data was analysed using MINITAB 12.21 Atlanta USA statistical software.Result: Anaemia (˂110 g/L) was present in 88.0% of the HIVinfected children, compared to 15.0% of controls (p = 0.001). Mild anaemia (70 – 109 g/L) was observed in 85.0% of HIVinfected children, compared to 15.0% of controls. Moderate anaemia (50 – 69 g/L) was present in 3.3% of HIV-infected children, but in none of the control. Leucopenia (˂4 × 109/L) was seen in 11.6% of HIV-infected children and in 5.0% of controls. Neutropenia (˂1.5 × 109/L) affected13% of infected children and 5% of controls. Lymphocytopenia (˂1.2 × 109/L) was observed in 3.3% of infected children but in none ofcontrols. Corresponding figures for thrombocytopenia (˂100 × 109/L) were6.7% of HIV infected children and 1.7% of controls.Conclusion: All cells lines arereduced in HIV/AIDS and anaemia is the most frequent haematological manifestation seen in HIV/AIDS infection.Key words: Prevalence, Anaemia; HIV, Paediatrics, Patients