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Tan Y, Che L, Bi H, Fan S, Zhou Z, Min H. Clinical features and treatment effect of HIV-associated immune thrombocytopenia-single center Ten-Years data summary. Platelets 2023; 34:2200836. [PMID: 37114424 DOI: 10.1080/09537104.2023.2200836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Thrombocytopenia represents one of the most prevalent hematologic complications observed in patients infected with the human immunodeficiency virus (HIV). In this study, we sought to analyze the clinical characteristics and treatment outcomes of patients with coexisting HIV and thrombocytopenia. Specifically, we retrospectively examined the medical records of 45 patients diagnosed with HIV/AIDS and thrombocytopenia at the Yunnan Infectious Diseases Specialist Hospital between January 2010 and December 2020, all of whom received highly active antiretroviral therapy (HAART) with/without glucocorticoids. The median follow-up period was 79 days, ranging between 14 and 368 days, the total platelet count was higher after receiving treatment than before (Z = -5.662, P < .001). Among the cohort, 27 patients (60.0%) responded to treatment, with 12 patients (44.44%) experiencing relapse during the follow-up period. The response rate (80.00%) of newly diagnosed ITP were significantly higher than of persistent ITP (28.57%) and chronic ITP (38.46%) (\x 2 = 9.560, P = .008) and the relapse rate of the newly diagnosed ITP (30.00%) was significantly lower than the persistent ITP and chronic ITP (100.00%, 80.00%) (\x2 = 6.750, P = .034). Notably, we found that the number of CD4+ T cells, duration of HIV infection, selection of HAART and type of glucocorticoids administered displayed no statistically significant effect on platelet count, treatment response, or relapse rate. However, we observed a significant decrease in platelet count in hepatitis C virus-positive individuals coinfected with HIV compared to those with HIV alone (Z = -2.855, P = .003). Our findings suggest that patients diagnosed with HIV and thrombocytopenia exhibit a low response rate to treatment and have an increased likelihood of relapse.
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Affiliation(s)
- YaXian Tan
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - Lei Che
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - Hui Bi
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - ShanShan Fan
- Department II of Infectious Diseases, Yunnan Infectious Diseases Specialist Hospital, Kunming, Yunnan, China
| | - ZePing Zhou
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, Chinaand
| | - HaiYan Min
- Department II of Infectious Diseases, Yunnan Infectious Diseases Specialist Hospital, Kunming, Yunnan, China
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Usman A, Balogun O, Shuaib BI, Musa BOP, Yusuf AA, Ajayi EIO. Prevalence of Cytopenia and its Correlation with Immunosuppression in Naïve HIV-1 Infected Patients Initiating First-Line Antiretroviral Therapy: A Pilot Study. Infect Chemother 2023; 55:479-489. [PMID: 38183393 PMCID: PMC10771947 DOI: 10.3947/ic.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Cytopenias serve as common indicators and crucial predictive tools for evaluating disease progression and therapeutic outcomes in individuals with human immunodeficiency virus (HIV) infection. This study aimed to assess the prevalence of cytopenias and their correlation with the level of immunosuppression in treatment-naive HIV-infected participants after initiating highly active combined antiretroviral drug therapy (cART24). MATERIALS AND METHODS This prospective study focused on evaluating cytopenia in 44 treatment-naive HIV-infected patients who consented to initiate cART and were consecutively enrolled. The research was conducted at the Nasara HIV Treatment & Care Centre of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, spanning from December 2016 to January 2018. Cytopenias, including anemia, leucopenia, lymphocytopenia, and thrombocytopenia, were defined and assessed according to World Health Organization guidelines. A combination of cross-sectional and longitudinal mixed-design two-step analysis was employed to validate our findings. RESULTS The median time from enrollment to cART initiation was 7 days, following the universal test and treat protocol. The prevalence of cytopenia was 75% at the baseline before treatment and increased to 84% after cART24 administration. There were no statistically significant differences in the median values of immuno-hematological parameters between baseline and after cART24 initiation (P >0.05). In terms of longitudinal assessment, the prevalence of anemia, leucopenia, lymphopenia, and thrombocytopenia at baseline were 66%, 23%, 0%, and 11%, respectively, and after cART24, the rates were 66%, 29%, 5%, and 20%. Notably, the prevalence of cytopenia correlated with declining CD4+ T cell counts. Among instances of unicytopenia, 58% exhibited isolated anemia, 6% had lone leucopenia, and 6% had solitary thrombocytopenia. Additionally, 27% demonstrated bi-cytopenia, and 3% exhibited pancytopenia. Interestingly, none of the study participants presented with lymphopenia. The most common combination was anemia and thrombocytopenia. Both longitudinal and cross-sectional analytical findings were consistent. CONCLUSION In treatment-naive HIV-infected individuals, the prevalence of cytopenias, particularly anemia and thrombocytopenia, was substantial and correlated with the degree of immunosuppression as indicated by CD4+ T cell counts. These cytopenias persisted despite initiation of cART24, highlighting the complexity of hematological manifestations in HIV infection. Our study underscores the significant hematopathological impact of HIV and antiretroviral therapy, highlighting the necessity for preventive strategies to mitigate these adverse effects.
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Affiliation(s)
- Abdulrasheed Usman
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Science Ahmadu Bello University, Zaria, Nigeria.
| | - Olayemi Balogun
- Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Bukhari Isah Shuaib
- Department of Medical Laboratory Science, Faculty of Applied Health Science Edo State University, Uzairue, Edo State, Nigeria
| | - Bolanle O P Musa
- Immunology Unit, Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Aminu Abba Yusuf
- Department of Haematology, Faculty of Clinical Sciences, Bayero University/Department of Haematology and Blood Transfusion, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ebenezer I O Ajayi
- DC&ONID, Department of Biochemistry, Faculty of Basic and Applied Sciences, Osun State University, Osogbo, Nigeria
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Wei L, Zhao Y, Gan X, Zhao D, Wu Y, Dou Z, Ma Y. The burden of anemia among Chinese HIV-infected patients following the initiation of antiretroviral therapy in the treat-all era: a nationwide cohort study. BMC Infect Dis 2023; 23:704. [PMID: 37858044 PMCID: PMC10588238 DOI: 10.1186/s12879-023-08675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era. METHODS All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death. RESULTS Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80-3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67-6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55-2.76; moderate anemia: aHR = 4.60; 95% CI:4.40-4.81; severe anemia: aHR = 6.41; 95% CI:5.94-6.91). CONCLUSIONS In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.
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Affiliation(s)
- Lai Wei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yan Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China.
| | - Xiumin Gan
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Decai Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yasong Wu
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Zhihui Dou
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Ye Ma
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
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Global Prevalence and Associated Clinical Markers of Thrombocytopenia in People Living with HIV: Evidence from Meta-Analysis. Clin Pract 2022; 12:867-875. [PMID: 36412670 PMCID: PMC9680325 DOI: 10.3390/clinpract12060091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Thrombocytopenia is one of the complications in human immunodeficiency virus (HIV) patients. To improve the health outcomes of patients living with HIV, it is important to understand the prevalence and pattern of associated key clinical markers globally. This meta-analysis, therefore, aimed to estimate the pooled prevalence of and associated clinical marker of thrombocytopenia globally. Methodology: The meta-analysis was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All statistical analyses were conducted using Stata. Twelve full-text papers out of 454 were eligible for meta-analysis. Results: Among 6686 participants, overall pooled prevalence of thrombocytopenia was 10.90% (95% CI: 7.91, 13.88) I2 = 93.62%. In addition, thrombocytopenia was more prevalent by 25.11% (95% CI: 13.33, 36.88) in patients with CD + T < 200 cells/μL, and less prevalent in patients with CD + T < 200 cells/μL 10.10% (95% CI: 7.37, 12.83), respectively. Conclusions and recommendations: This meta-analysis established the prevalence of thrombocytopenia among patients living with HIV, and that it may be more prevalent in patients with CD + T < 200 cells/μL indicating the necessity of routine screening for various haematological markers and a careful treatment plan for HIV patients.
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Adeola OO, Kolawole OE, Yemi AF, Hilda AE, Samson AT, Kola OJ. Occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria. J Family Med Prim Care 2022; 11:5332-5339. [PMID: 36505610 PMCID: PMC9731083 DOI: 10.4103/jfmpc.jfmpc_1361_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Human immunodeficiency virus (HIV) and malaria infections are among the major public health concerns in sub-Saharan Africa, where they are associated with high morbidity and mortality. The study was conducted to assess the occurrence and clinical features of HIV and malaria in co-infected individuals in Osun State, Nigeria. Methods The study was cross-sectional, which involved 422 participants who were administered structured questionnaires for socio-demographic and clinical data. Venous blood was collected for malaria parasite detection and count from One hundred and seventy-four HIV seropositive individuals. They were re-examined clinically for HIV diagnosis, CD4 + T cell counts, and packed cell volume (PCV). Results The mean age of the participants was 28.48 ± 15.38 while the overall predominance of malaria among the HIV-positive patients was 11.5% (20/174). The malaria prevalence was significantly higher in female patients (P = 0.0088) and occupational status among students (P = 0.0001). Malaria/HIV co-infected patients had a significantly lower mean value of PCV (P = 0.0001), CD4 + cell count (0.0001), and temperature (0.0001) compared to HIV-infected patients having no malaria. Conclusion The study showed that females had relatively higher malaria infection compared to their male counterparts. To achieve better management of HIV patients against malaria infection, proper preventive measures, antiretroviral therapy (ART), and chemoprophylaxis are a useful strategy to put in place. Also, the monitoring of CD4 + cell count, viral load, and some hematology indices on a regular basis is crucial.
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Affiliation(s)
- Oyeniran O. Adeola
- Department of Pure and Applied Biology (Microbiology Unit), Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Oladipo E. Kolawole
- Department of Microbiology, Laboratory of Molecular Biology and Bioinformatics, Adeleke University, Ede, Osun State, Nigeria,Address for correspondence: Dr. Oladipo E. Kolawole, Department of Microbiology, Laboratory of Molecular Biology and Bioinformatics, Adeleke University, PMB 250, Ede, Osun State, Nigeria. E-mail:
| | - Abiodun F. Yemi
- Department of Medical Laboratory Sciences, Ambrose Ali University, Ekpoma, Edo State, Nigeria
| | - Awoyelu E. Hilda
- Department of Physiology, Obafemi Awolowo University, Ile-ife, Osun State, Nigeria
| | - Adu T. Samson
- Department of Physiology, Obafemi Awolowo University, Ile-ife, Osun State, Nigeria
| | - Oloke J. Kola
- Department of Pure and Applied Biology (Microbiology Unit), Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria,Department of Natural Sciences (Microbiology), Precious Cornerstone University, Ibadan, Oyo State, Nigeria
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Tilahun M, Gedefie A, Ebrahim E, Seid A, Ali A, Shibabaw A, Belete MA, Fiseha M, Tesfaye M, Ebrahim H, Abera A. Immuno-Haematological Abnormalities of HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Therapy in the Antiretroviral Therapy Clinics of Six Health Facilities at Dessie Town, Northeast Ethiopia. J Blood Med 2022; 13:243-253. [PMID: 35592587 PMCID: PMC9112337 DOI: 10.2147/jbm.s364700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background In people living with the human immunodeficiency virus, haematological abnormalities have been linked to an increased risk of disease progression and mortality. Hematological parameters may have a positive or negative impact on antiretroviral therapy. The aim of this study was to assess the immuno-haematological abnormalities of HIV-infected patients before and after the initiation of highly active antiretroviral therapy in the antiretroviral therapy clinics of six health facilities in Dessie, Northeast Ethiopia. Methods A facility-based cross-sectional study was conducted from April to May 30, 2021, at the antiretroviral therapy clinics of six health facilities in Dessie Town. A total of 378 HIV-infected patients taking highly active antiretroviral treatment for at least 6 months by using a consecutive sampling technique were included. A well-organized questionnaire was used to collect socio-demographic and clinical information. Immune-haematological parameters were tested using a Mindray BS-300 hematology analyzer and a BD FACS count CD4 analyzer. Statistical analysis was performed using SPSS version 25 statistical software. Statistical significance was defined as a P-value of 0.05 with a 95% confidence interval. Results Leukopenia was found in 26.7% and 16.5%, neutropenia in 16.5% and 9.4%, lymphopenia in 20% and 3.1%, and thrombocytopenia in 25.9% and 7.1% of HIV patients before and after HAART initiation, respectively. There was a significant difference in total white blood cell, absolute neutrophil, red blood cell, hemoglobin value, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet and CD4+ T cell counts in HIV patients before and after the initiation of HAART with P < 0.05. Conclusion and Recommendation Anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia were the most common haematological abnormalities found in this study before and after HAART initiation. The prevalence of thrombocytopenia, immunosuppression, and viral load was reduced considerably after starting HAART.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Mihret Tilahun, Department of Medical Laboratory Science College of Medicine and Health Sciences, Wollo University, Po.Box: 1145, Dessie, Ethiopia, Tel +251-920988307, Fax +251 333115250, Email
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Abdurrahman Ali
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melkam Tesfaye
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Admasu Abera
- Department of Medical Laboratory Science, Debre Birhan health Science college, North Showa, Ethiopia
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