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

Magnitude and Factors Associated with Cytopenia Among Children on Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Science, Sidama Region, Southern Ethiopia

Background

The most common abnormality in HIV-infected children is cytopenia, a hematological complication characterized by a decline in any of the blood cell lines. It is associated with a higher risk of morbidity and mortality. Therefore, this study aimed to assess the prevalence and associated factors of cytopenia among HIV-positive children on highly active antiretroviral therapy (HAART).

Methods

Hospital-based cross-sectional study design was conducted on HIV-positive children on HAART from July to September 2020. Socio-demographic and clinical characteristics of the study participants' data were collected using a structured questionnaire. Hematological parameters from the blood sample were analyzed using Ruby Cell-Dyne 300 hematology auto-analyzer. The data were analyzed using SPSS version 20. Logistic regression was used to assess the predictors of cytopenia among the study participants. P-values of less than 0.05 are considered statistically significant.

Results

Two hundred seventy-three HAART-experienced children were enrolled in this study, and 50.9% were females. At baseline, 40.7% of children were anemic. The overall magnitude of cytopenia among the study participants was 26.7%. The prevalence of anemia, thrombocytopenia, leucopenia and neutropenia among children was 11.4%, 4.0%, 14.3%, and 18.3%, respectively. Patients with an undetectable viral load (AOR = 0.5, CI = 0.3-0.9) are 50% less likely to report cytopenia. HAART-experienced children living in rural areas are more likely to develop cytopenia (AOR = 2.6, CI = 1.3-5.2) than those living in urban areas.

Conclusion

Hematologic abnormalities are common problems among children on highly active antiretroviral therapy. Therefore, routine investigation of hematological and immunological changes following appropriate therapeutic interventions is recommended.

Malnutrition in HIV infected children on antiretroviral drugs in a cohort of Ghanaian children

Background

HIV infected children are at increased risk of malnutrition which worsens the depressed immune system, leading to poor disease prognosis.

Aim

To assess the nutritional status of children between 6-12 years on antiretroviral drugs (ARV) at two health facilities in Accra.

Methods

The study design was cross sectional among children between 6 and 12 years being administered with antiretroviral drugs at two hospitals in Accra. A purposive sample of 100 children was used. Height and weight measurements were taken and used to compute z-scores for stunting, underweight and wasting. Haemoglobin status was obtained from their folders. A semi-structured questionnaire was used to obtain sociodemographic data and a 24-hour dietary intake used to assess nutrient intakes. Data was analyzed using IBM SPSS version 20.0. Nutrient analysis was done using Micro diet version 3.0. Data was summarized using means and percentages. Chi-squared test was used to test for associations and statistical significance set at p < 0.05.

Results

The prevalence of stunting, underweight and wasting was reported as 28%, 16% and 13% respectively. Girls were more stunted and wasted compared to boys. Mean haemoglobin concentration was 10.12 ± 2.77 g/dl. Mild, moderate and severe anaemia were reported in 14.2%, 41.1% and 12.5% of the children respectively. Apart from carbohydrates, less than 50% of the children were able to meet their requirements for the other nutrients”.

Conclusions

Our findings reveal high level of malnutrition among the children receiving ARV. There is the need for targeted nutrition interventions to improve the nutritional status of the children.

Anemia among children living with HIV/AIDS on HAART in Mekelle Hospital, Tigray regional state of northern ethiopia - a cross-sectional study

BACKGROUND

Anemia is a common complication of HIV/AIDS in children. There is lack of evidence on anemia prevalence among children living with HIV/AIDS on highly active antiretroviral therapy (HAART) in Tigray regional state, which the current study aimed to generate.

METHODS

An institution-based cross-sectional study was conducted on 241 children living with HIV/AIDS on HAART attending the antiretroviral therapy (ART) clinic of Mekelle hospital from November 2018-January 2019. Socio-demographic data were collected using a structured pretested questionnaire. Participants' hemoglobin level was utilized to determine the prevalence of anemia. WHO cut-off values for Hgb were used to categorise the severity of anemia. Microscopic examination was performed for morphological classification of anemia.

RESULTS

Among the participants, 7 % (n = 16) were anemic in this study. Of these, 56 %, 19 %, and 25 % had mild, moderate, and severe anemia, respectively. Morphologically, normocytic-normochromic anemia was found the most common type of anemia in this study.

CONCLUSIONS

The prevalence of anemia among participants was low in this study. However, a considerable proportion of participants had severe anemia, requiring regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements.

Virological failure and associated factors among children receiving anti-retroviral therapy, Northwest Ethiopia

BACKGROUND

Virological failure is under-recognized issue among children living with human immunodeficiency virus in developing countries. This partly may lead to failure to achieve the global goal of 90-90-90 targets in most developing countries including Ethiopia.

OBJECTIVES

This study aimed to assess the virological failure and its predictors among children receiving antiretroviral therapy at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

METHODS

An institutional based cross-sectional study was conducted among 253 study cohorts from January 2020-April 2021. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview, while detailed clinical data of the children were collected by reviewing the medical record. About 5 ml of blood were collected for the analysis of complete blood count and viral load quantification. Data were analyzed using SPSS version 20 and variables at p-value < 0.05 in the multivariable analysis were considered as statistically significant.

RESULTS

In this study, the viral load suppression rate among antiretroviral therapy experienced children was 68.8%. Meanwhile, the overall virological failure among study participants was 19.4%. Children living without family (AOR = 3.63; 95%CI: 1.27-10.24), children with unemployed family (AOR = 4.95; 95%CI: 1.74-14.12), being wasted (AOR = 3.02; 95%CI: 1.19-7.67) being stunted (AOR = 2.38;95%CI:1.03-5.46), anemia (AOR = 5.50:95%CI;1.37-22.04) and being lymphopenic (AOR = 2.69:95%CI;1.04-7.75) were significantly associated with virological failure among children under treatment.

CONCLUSION

Higher virological failure among children was noteworthy in the present study. Caretakers other than immediate family, unemployed family, wasted, stunted, anemia, and lymphopenia were significant independent predictors of virological failure. Hence, standard, and optimal management of children under treatment should be warranted.

Time to detection of anemia and its predictors among children living with HIV at Debre Tabor and University of Gondar Compressive Specialized Hospitals, 2020: a multicentre retrospective follow-up study

BACKGROUND

Even though antiretroviral therapy access for HIV infected children increased dramatically, anemia have been continued as a challenge regardless of a cluster of differentiation (CD4) count and viral load. Hence, this study aimed to assess the time to detection of anemia and its predictors among children living with HIV at Debre Tabor and university of Gondar compressive specialized hospital, 2020.

METHODS

A retrospective follow-up study was conducted from January 2010 to December 2018. A total of 372 children under the age of 15 who had received ART were included in the study. Data were collected from children's medical charts and ART registration logbook using a standard checklist. Besides, the data were entered into Epi data 4.2.2 and then exported to Stata 14.0 for further analysis. The Cox regression model, the variables having P-value ≤.05 with 95% CIs in multivariable analysis were declared as statistically significant for anemia.

RESULT

The mean (±SD) of follow-up periods were 56.6 ± 1.7 SD months. The overall median survival time free from anemia was 137 months, and the incidence rate of anemia was 6.9 per 100 PYO (95% CI: 5.3, 7.8). Moreover, WHO clinical staging of III/IV [AHR: 4.2, 95% CI: 1.80, 11.1], low CD4 count below threshold [AHR: 1.9, 95% CI: 1.09, 3.37], cotrimoxazole preventive therapy non-users, and poor level of adherence [(AHR: 2.4, 95% CI: 1.20, 4.85] were the main predictors of the time to detection of anemia.

CONCLUSION

The incidence rate of anemia in our retrospective cohort was high. The risk of anemia is present in children living with HIV infection but the risk for anemia is increased based on (WHO clinical staging III and IV, CD4 count below the threshold level, CPT non-users, and poor level of adherence). Since many of these risk factors are present routinely, even within one single patient, our clinical monitoring for anemia quarterly was fully justified as was our routine switch from standard therapies such as AZT to another regimen upon lab confirmation of anemia. Additional methods to improve cotrimoxazole preventative therapy and level of adherence are also needed.

Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

BACKGROUND

Isolated or multi lineage cytopenia are the most common clinicopathological features and independently associated with increased risk of disease progression and death among human immunodeficiency virus infected children. In the study area, there is scarcity of data about the magnitude of various cytopenia.

OBJECTIVES

Aimed to determine the magnitude and associated factors of peripheral cytopenia among HIV infected children at the University of Gondar Specialized Referral Hospital ART clinic, Northwest Ethiopia.

METHODS

Institutional based cross-sectional study was conducted on 255 HIV infected children from January- April 2020. None probable convenient sampling technique was used to select the study participant. Socio demographic data were collected by pre tested structured questionnaire via face-to-face interview and their medical data were obtained from their follow-up medical records. Moreover, blood specimens were collected and examined for complete blood count, viral load and blood film, whereas stool specimens were collected and examined for intestinal parasites. Bi-variable and multi-variable logistic regression models were fitted to identify associated factors of cytopenia. P-Value <0.05 was considered as statistically significant.

RESULT

The overall magnitude of peripheral cytopenia was 38.9%. Anemia, leukopenia, lymphopenia, thrombocytopenia and bi-cytopenia were 21.2%, 12.2%, 11%, 1.6% and 3.9% respectively. Being in the age group of 2-10 years (AOR = 5.38, 95%CI 2.33-12.46), AZT based regimen (AOR = 5.44, 95%CI: 2.24-13.21), no eating green vegetables (AOR = 2.49, 95% CI: 1.26-4.92) and having plasma viral load >1000 copies /ml (AOR = 5.38, 95%CI: 2.22-13.03) showed significant association with anemia.

CONCLUSION

Anemia was the predominant peripheral cytopenia among HIV infected children in this study. It was strongly associated with AZT based drug type, age below 10 years and high viral load. Critical stress should be given for early investigation and management of cytopenia in addition to the use of alternative drug which leads to higher viral suppression and lower risk of toxicity issue.

<p>Incidence and Predictors of Anemia Among Children on Antiretroviral Therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2007–2017: A Retrospective Follow-Up Study</p>

Background

Anemia is the most common hematological abnormality among children on antiretroviral therapy. In Ethiopia, as far as our search, there are no studies done on the incidence and predictors of anemia among children on antiretroviral therapy. This study aimed to assess the incidence and predictors of anemia among children on antiretroviral therapy, attending antiretroviral therapy care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from 2007 to 2017.

Methods

A retrospective follow-up study was conducted among 391 children on antiretroviral therapy. Mean survival time for children to be anemia free was estimated. A Log rank test was used to compare survival curves among different independent variables. The Cox regression model was used. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was calculated. P-value ≤0.05 was considered as statically significant.

Results

The overall incidence rate of anemia was 10.5 (95% confidence interval (8.6, 12.8)) per 100 child-year. Being severe-immunosuppressed (AHR=2.9, 95% CI: 1.23–6.77), undernutrition (AHR =2.7, 95% CI: 1.5–5), taking zidovudine-based ART regimen (AHR =4, 95% CI: 1.23–12.9), and tuberculosis (AHR =2.1, 95% CI: 1.4–3.3) were independent predictors of anemia among children.

Conclusion

In this study, the incidence rate of anemia among children on antiretroviral therapy was found to be high. Tuberculosis, zidovudine-based drugs, severe immunosuppression, and undernutrition have remained statically significant predictors of anemia among children on antiretroviral therapy. Children with HIV were the most vulnerable group for anemia, especially in developing countries. Therefore, improving their nutritional status and considering other predictors of anemia were very important for children to reduce the incidence of anemia among children with HIV.

Severe Anemia Is Associated with Systemic Inflammation in Young Children Presenting to a Tertiary Hospital in Uganda

The role of inflammation in severe anemia (SA) in African children has not been well characterized. We conducted a study to evaluate risk factors for SA in young children admitted at a tertiary unit in Uganda. Clinical, infectious, and micronutrient risk factors for anemia, along with markers of inflammation, were evaluated in children aged < 5 years in Jinja Hospital, Uganda. Participants included 284 children with SA (Hemoglobin [Hb] < 5.0 g/dL), and two control groups: 63 children admitted with acute illness without SA (Hb > 9.3 g/dL) and 53 asymptomatic community control children. Appropriate logistic analysis was performed to determine factors associated with SA. Of the 284 children with SA, 36.5% had Plasmodium falciparum parasitemia, 32.7% had blackwater fever (one of the types of severe malaria), and 15.5% had vitamin B12 deficiency. HIV infection, bacteremia, hookworm infection, severe acute malnutrition, and folate deficiency were relatively uncommon (each accounting for < 8%). Factors independently associated with SA compared with the combined control groups included (adjusted odds ratio [OR]; 95% CI) the following: P. falciparum parasitemia (OR: 4.3; 95% CI: 1.4-13.8), total white blood count (OR: 1.3; 95% CI: 1.1-1.4), C-reactive protein (OR: 1.8; 95% CI: 1.3-2.4), and ferritin (OR: 2.7; 95% CI: 1.9-4.0). In this area of Uganda, malaria and markers of inflammation were independently associated with SA in children. Additional studies are required to determine the role of inflammation in children with SA in this population.

Magnitude of Anemia and Associated Factors among HIV-Infected Children Receiving Antiretroviral Therapy in Pastoral Community, Ethiopia: A Retrospective Cross-Sectional Study

Background

The two major comrbidities (anemia and poor nutrition) are common manifestations of HIV-infected children, which threaten their lives. In Ethiopia, there is limited information on the magnitude and factors associated with anemia among HIV-infected children. Thus, this study was aimed to determine the magnitude and factors associated with anemia among HIV-infected children receiving antiretroviral therapy in the Afar region, Ethiopia.

Methods

A cross-sectional retrospective record review was conducted on a sample size of 102 HIV-infected children aged 6 months to < 15 years in selected ART sites of the Afar region from May 1 to 25, 2018. Patient cards from 2009 to 2017 with the required information were considered. A paired sample t-test was used to assess whether there is a significant difference in the hemoglobin level before and after the HAART regimen. Multivariable logistic regression was used to determine predictors of anemia. Statistical significance was determined atp value < 0.05.

Result

At baseline, 53.9% of study participants were anemic, from which 8.7%, 36.3%, and 9.8% were mild, moderate, and severe, respectively. There was a statistically significant improvement of hemoglobin level following the one-year course of ART treatment from 10.67 ± 1.82 to 11.5 ± 1.5 (p value ≤ 0.001): an improvement of 0.83 ± 1.74. Children who were moderately and severely stunted were more than five (AOR = 5.16, 95% CI (1.71, 15.56)) and more than twelve (AOR = 12.45, 95% CI (2.62, 59.21)) times more likely to be anemic than children who were not stunted, respectively. Children whose mothers had not attended ANC follow-up were more than three (AOR = 3.68, 95% CI (1.38, 9.81)) times more likely to be anemic than children whose mothers attended ANC. Children who were in clinical stages 3 and 4 were more than five (AOR = 5.07, 95% CI (1.79, 14.37)) times more likely to be anemic than children who were in clinical stage 1 and 2.

Conclusion

The magnitude of anemia among HIV-infected children was found to be high, which is 53.9%. Nutritional status (stunting), WHO clinical stage, and history of ANC follow-up were the predictors significantly associated with childhood anemia. Thus, interventions for HIV-infected children should consider those factors.

Magnitude of anemia and undernutrition among HIV-infected children who took HAART: a retrospective follow-up study

BACKGROUND

Human immunodeficiency virus (HIV) is a virus that affects the immune system, the body's natural defence system. It is a virus spreading through certain body fluids that attacks the body's immune system, specifically the Cluster of Differentiation 4 (CD4) T-cells. Anemia is a common manifestation of pediatric HIV infection and is a significant negative predictor of survival. Moreover, undernutrition is the underlying cause of death among 35% of children aged under 5 years, and it has been negatively implicated with antiretroviral therapy (ART) outcomes, particularly in developing countries. The aim of this study was to determine the magnitude of anemia and undernutrition among HIV-infected children within the first year of ART initiation at University of Gondar comprehensive specialized hospital ART clinic.

METHODS

Records of 200 children aged <15 years old who were on ART at the University of Gondar comprehensive specialized hospital from 2005 to 2017 were retrospectively reviewed in 2017. Baseline characteristics and one-year flow-up data after ART initiation were extracted from the medical records. Anemic status was determined based on the hemoglobin (Hb) level in accordance with World Health Organization (WHO) guideline. The nutritional status was calculated based on anthropometric measurements. Generalized Estimating Equation (GEE) was fitted to identify factors associated with anemia and undernutrition. Odds ratio with the corresponding 95% Confidence interval (CI) was reported.

RESULTS

Of the total children, 75 (37.5%) (95% CI: 30.73-44.27%) were anemic at the baseline of ART initiation. The magnitude of anemia has shown a persistent decline from the baseline to 12th months of ART initiation. At ART initiation, the magnitude of undernutrition was high, 64% (95% CI: 57.3-70.7%). Similarly, the magnitude of undernutrition showed decrement during a one year ART initiation period. Stunting was the most common type of undernutrition at baseline (49.5%), 6 months (44%), 9 months (41%), and 12 months (39%) of ART initiation. Baseline CD4 count, Baseline WHO clinical stage and age at enrollment to the care were significantly associated with anemia within the first year of ART initiation.

CONCLUSION

Despite a decline in the first year of ART initiation, anemia and undernutrition were public health problems in HIV-infected children. Hence, for HIV-infected children taking HAART, emphasis should be given to manage anemia and undernutrition within the first year of ART initiation.

Factors affecting adherence to treatment in children living with HIV

Background:

With the successful introduction of ART, the life expectancy of children living with HIV (CLHIV) is substantially increased. However, strict compliance is a necessary step to begin with as noncompliance is again associated with its own demerits of incomplete suppression and decreasing the overall survival of the patients.

Aims:

The aim of this study was to measure factors associated with adherence to ART among CLHIV.

Materials and Methods:

This is a 1-year follow-up study conducted from November 2012 to December 2013. A total of 171 children between 18 months and 15 years living with HIV and on ART attending the two ART centers of Delhi were enrolled in the study. Adherence and factors affecting adherence were obtained from the study participants using a semi-structured interview schedule.

Statistical Analysis Used:

Collected data were transformed into variables and analyzed into SPSS. All observations were in terms of mean, median, standard deviations, percentages, and proportions. Tests of significance such as Chi-square test and t-test were applied wherever required.

Results:

In nearly 89% of the study participants, adherence to ART was ≥95% at the end of the study. The most common reason for nonadherence was forgetfulness (59%), and 57% of the parents/caretakers were facing monetary problems. Long distance, greater duration to reach center, and unavailability of the parents/caretakers were also quoted as problems.

Conclusion:

Adherence is genesis to successful treatment outcome and is strongly associated with availability of support by their parents/caretakers. Professional help along with guidance and encouragement is required not only at the caretaker level but also to the family as a whole.

Multiple Concurrent Illnesses Associated with Anemia in HIV-Infected and HIV-Exposed Uninfected Children Aged 6-59 Months, Hospitalized in Mozambique

Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6–59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7–9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in high-burden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one’s anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non–disease specific approaches to pediatric anemia management and should include improved access to blood culture.

Anemia and Related Factors Among Highly Active Antiretroviral Therapy Experienced Children in Hawassa Comprehensive Specialized Hospital, Southern Ethiopia: Emphasis on Patient Management

Background

Human Immunodeficiency Virus (HIV) and its therapy cause a variety of hematological abnormalities that have been known to be one of the most common causes of morbidity and mortality in HIV-positive children. One of the commonly observed hematologic manifestations in HIV-positive children is anemia and it has a multifactorial source. We intended to assess the prevalence, as well as its related factors of anemia among Highly Active Antiretroviral Therapy (HAART), experienced children.

Methods

A hospital-based cross-sectional study was employed at Hawassa comprehensive specialized hospital from February 15-June 15, 2018. Overall, 273 HAART-practiced children were included in the study. Socio-demographic variables and clinical data were collected using a standard and pretested questionnaire. Medical records were reviewed for each study participant using a standard checklist. Blood specimens were collected and examined for complete blood count, CD4 cell count and blood film for hemoparasites and morphological classification of anemia, whereas stool specimens were collected and examined for intestinal parasites. Data were entered into Epidata and transferred to SPSS (Statistical Package for Social Science) version 20 software. Descriptive analysis was done for prevalence and binary and multivariate logistic regression was used to determine factors associated with anemia. Statistical significance was stated at P-value<0.05.

Results

The overall prevalence of anemia in this study was 11.4%. Morphologically the predominant anemia was Normocytic Normochromic anemia which accounted for 64.5%. In the current study, children within the age group of <7years (AOR: 3, CI: 1.2-7.5, P=0.02), those who were rural residents (AOR: 2.6, CI: 1.0-6.6, P=0.042) and those with viral load >150 copies/mL (AOR: 3.4, CI: 1.36-8.3, P=0.009) were found to be significantly associated with anemia.

Conclusion

The prevalence of anemia in this study was 11.4%. It was significantly associated with different factors such as age, residence and viral load. Therefore, regular follow-up management should be emphasized for HAART-experienced children. Hence, there is a need for a longitudinal study to be conducted further to explore the causes of anemia due to HIV and the pattern of hemoglobin changes with HAART- experienced children will be very important.

Determinants of Anemia among HIV-Positive Children on Highly Active Antiretroviral Therapy Attending Hospitals of North Wollo Zone, Amhara Region, Ethiopia, 2019: A Case-Control Study

Introduction. Anemia is one of the most commonly observed hematological abnormalities and an independent poor prognostic marker of HIV disease. The rate of progression and mortality in this subgroup of patients is high compared to nonanemic patients. WHO estimates that over two billion people are anemic worldwide and young children bear the world's highest prevalence rate of anemia. In Ethiopia, there is limited information about the determinant factors associated with anemia among HIV positive children. Thus, this study aimed to determine the determinant factors of anemia among HIV-infected children on HAART.

Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis

Background

Anemia is a common problem in HIV (human immunodeficiency virus) infected patients, and is associated with decreased functional capacity and quality of life. Ethiopia is one of the countries which has expanded highly active antiretroviral treatment (HAART) over the past years. The effect of HAART on anemia among HIV remains inconsistent and inconclusive, particularly in children. This study thus aimed to synthesize the prevalence of anemia among HIV infected Ethiopian children and its association with HAART initiation.

Methods

MEDLINE/PubMed, EMBASE, PsycINFO, Web of Science and Google scholar were used to identify 12 eligible studies reporting an association between anemia and HIV using a priori set criteria. PRISMA guideline was used to systematically review and meta-analysis these studies. Details of sample size, magnitude of effect sizes, including odds ratio (OR) and standard errors were extracted. Random-effects model was used to calculate the pooled estimates using STATA/SE version-14. I² and meta-bias statistics assessed heterogeneity and publication bias of the included studies. Sub-group analyses, based on study designs, were also carried out.

Results

In Ethiopia, the overall prevalence of anemia in HIV infected children was 22.3% (95% CI: 18.5–26.0%). The OR of anemia-HIV/AIDS comorbidity was 0.4 (95% CI, 0.2–0.5) in HAART initiated children as compared to non-initiated counterparts. Meta-bias and funnel plot detected no publication bias.

Conclusion

On aggregate, anemia is a common comorbidity in pediatric HIV patients. HAART was significantly associated with a reduced anemia-HIV/AIDS comorbidity. Prompt start of HAART might help decreasing the prevalence of anemia and its subsequent complications.

Immunological and Virological Responses to Highly Active Antiretroviral Therapy in HIV-1 Infected Children

OBJECTIVE

To evaluate immunological and virological outcomes in human immunodeficiency virus (HIV) infected children at six months of highly active antiretroviral therapy (HAART).

METHODS

Records of HIV infected children <15-y-old were reviewed to identify those who were initiated highly active antiretroviral therapy between 2010 and 2014 and had CD4+ T cell percentage and HIV-1 viral load report at baseline visit and after 6 mo of initiation of the treatment.

RESULTS

Seventy-four HIV infected children [26% girls, median age IQR 36 (24-108) mo] were included in the study. At the end of six months of HAART, median increase of 11% (6-15%) in CD4+ T cell percentage from the baseline levels was observed; nineteen (26%) children showed an increase in CD4+ T cell percentage of 15% or more at 6 mo. Viral load was undetectable (<47 copies/ml) in 27 (36.4%) children; 21 (28.3%) children had 47- < 500 copies/ml; 16 (21.6%) children had 500- < 10,000 copies/ml and 10 (13.5%) children had ≥10,000 copies/ml. At six months, only 15 (20.2%) children exhibited positive immuno-virological response to HAART (≥ 15% increase in CD4% and <47 HIV-1 RNA copies/ml).

CONCLUSIONS

While HAART was effective in improving the immunological and virological parameters in the index cohort of children, virological responses were less robust.

Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia

INTRODUCTION

There are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high.

OBJECTIVE

The aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART.

METHODOLOGY

A cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version.

RESULTS

The median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm³ with an IQR of (286, 765); this increased to 663 cells mm³ with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×10³ with an IQR of (2.1, 4.6) and after ART, it became 3×10³ with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8).

CONCLUSION

ART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.

Magnitude of cytopenias among HIV-infected children in Bahir Dar, northwest Ethiopia: a comparison of HAART-naïve and HAART-experienced children

Background

AIDS, caused by HIV, is a multisystem disease that affects hematopoiesis. The aim of this study was to assess cytopenias among HIV-infected children who had a follow-up at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted between April and May 2013. Systematic random sampling method was used to select the study participants. Descriptive statistics, independent t-test as well as chi-square and logistic regression were used for analysis. A p-value <0.05 was considered as statistically significant.

Results

A total of 224 children (112 highly active antiretroviral therapy [HAART]-naïve and 112 HAART-experienced) participated in the study. The magnitude of anemia, thrombocytopenia, neutropenia, leukopenia and pancytopenia among HAART-naïve HIV-infected children were 30.4%, 9.8%, 8%, 4.5% and 1.8%, respectively. The overall prevalence of anemia, neutropenia, thrombocytopenia, leukopenia and pancytopenia were 29.5%, 8.9%, 8%, 4.5% and 1.4%, respectively. Cluster of differentiation-4 percentage and mean corpuscular volume were significantly different between HAART-experienced and HAART-naïve children. Being of younger age and severely immunosuppressed were risk factors of anemia.

Conclusion

Anemia was the most common cytopenia, followed by neutropenia. Severe immunosuppression and younger age were significantly associated with anemia. Therefore, emphasis should be given for investigation and management of cytopenias in HIV-infected children, particularly for those who are immunosuppressed and of younger age.

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

BACKGROUND

Malaria 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.

METHODS

A 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.

RESULTS

A 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).

CONCLUSION

Implementation 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.

HIV-infected children in the Asia-Pacific region with baseline severe anemia: antiretroviral therapy and outcomes

BACKGROUND

Severe anemia is common among children infected with human immunodeficiency virus (HIV). The choice of antiretroviral (ART) regimen needs careful consideration. No information is available regarding the initial ART regimens used in the Asia-Pacific region and the rate of switch of ART regimens in HIV-infected children with severe anemia.

OBJECTIVES

To study the initial ART regimens and the rate of switch of ART regimens used during the first 36 months in HIV-infected children with severe anemia and to evaluate their clinical and laboratory outcomes.

METHODS

We analyzed regional cohort data of 130 Asian children aged <18 years with baseline severe anemia (hemoglobin <7.5 g/dl) who started antiretroviral therapy (ART) between January 2003 and September 2013.

RESULTS

At ART initiation, median age was 3.5 years old (interquartile range (IQR) 1.7 to 6.3) and median hemoglobin was 6.7 g/dL (IQR 5.9-7.1, range 3.0-7.4). Initial ART regimens included stavudine (85.4%), zidovudine (13.8%), and abacavir (0.8%). In 81 children with available hemoglobin data after 6 months of ART, 90% recovered from severe anemia with a median hemoglobin of 10.7 g/dL (IQR 9.6-11.7, range 4.4-13.5). Those starting AZT-based ART had a mortality rate of 10.8 (95% confidence interval (CI) 4.8-23.9) per 100 patient-years compared to 2.7 (95% CI 1.6-4.6) per 100 patient-years among those who started d4T-based ART.

CONCLUSIONS

With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.

Anemia, diet and therapeutic iron among children living with HIV: a prospective cohort study

BACKGROUND

Children living with HIV have higher-than-normal prevalence of anemia. The beneficial effect of therapeutic iron has been questioned in the setting of high prevalence of infections. This study examines anemia prevalence and effect of standard therapeutic iron on HIV disease progression among children.

METHODS

Perinatally-infected children aged 2-12 years were enrolled at three sites in southern India, and were followed for 1 year with clinical assessments, dietary recall and anthropometry. Laboratory parameters included iron markers (ferritin, soluble transferrin receptor) and other micronutrient levels (vitamin A, B12, folate). Iron was given to anemic children based on WHO guidelines. Statistical analyses including frequency distributions, chi square tests and multivariate logistic regression were performed using Stata v13.0.

RESULTS

Among 240 children enrolled (mean age 7.7 years, 54.6% males), median CD4 was 25%, 19.2% had advanced disease, 45.5% had malnutrition, and 43.3% were on antiretroviral treatment (ART) at baseline. Anemia was prevalent in 47.1% (113/240) children. Iron deficiency was present in 65.5%; vitamin A and vitamin B12 deficiency in 26.6% and 8.0% respectively; and anemia of inflammation in 58.4%. Independent risk factors for anemia were stunting, CD4 < 25%, detectable viral load ≥ 400 copies/ml and vitamin A deficiency. Inadequate dietary iron was prominent; 77.9% obtained less than two-thirds of recommended daily iron. Among clinically anemic children who took iron, overall adherence to iron therapy was good, and only minor self-limiting adverse events were reported. Median hemoglobin rose from 10.4 g/dl to 10.9 mg/dl among those who took iron for 3 months, and peaked at 11.3 mg/dl with iron taken for up to 6 months. Iron was also associated with a greater fall in clinical severity of HIV stage; however when adjusted for use of ART, was not associated with improvement in growth, inflammatory and CD4 parameters.

CONCLUSIONS

Children living with HIV in India have a high prevalence of anemia mediated by iron deficiency, vitamin A deficiency and chronic inflammation. The use of therapeutic iron for durations up to 6 months appears to be safe in this setting, and is associated with beneficial effects on anemia, iron deficiency and HIV disease progression.

Prevalence and factors associated with severe anaemia amongst under-five children hospitalized at Bugando Medical Centre, Mwanza, Tanzania

Background

Anaemia is a major public health problem in developing countries, contributing significantly to morbidity and mortality amongst children under-five years of age. About 43 % of under-fives are anaemic worldwide, and two-thirds reside in sub-Saharan Africa. Even where blood transfusion is available for treatment there is still a significant case fatality rate ranging between 6 and 18 %. This study aimed to determine the prevalence and morphological types of anaemia, as well as factors associated with severe anaemia in under-five children admitted at Bugando Medical Centre (BMC).

Methods

This was a hospital-based, cross-sectional study conducted between November 2012 and February 2013. Selected laboratory investigations were done on children admitted to BMC. Anaemia was defined using WHO criteria.

Results

A total of 448 under-five children were recruited into the study. The overall prevalence of anaemia was 77.2 % (346/448) with mild, moderate and severe anaemia being 16.5, 33 and 27.7 % respectively. Microcytic hypochromic anaemia was detected in 37.5 % of the children with anaemia. Of 239 children with moderate and severe anaemia, 22.6 % (54/239) had iron deficiency anaemia based on serum ferritin level less than12 μg/ml. The factors associated with severe anaemia included unemployment of the parent, malaria parasitaemia and presence of sickle haemoglobin.

Conclusion

The prevalence of anaemia among under-five children admitted at BMC was high. Iron deficiency anaemia was the most common type. Factors associated with severe anaemia were unemployment among caretakers, malaria parasitaemia and presence of sickle haemoglobin.

Prevalence and associated risk factors of anemia among HIV infected children attending Gondar university hospital, Northwest Ethiopia: a cross sectional study

BACKGROUND

Anemia is the most common hematological abnormalities in HIV patients and it is a wide spread public health problem. The World Health Organization estimates that over 2 billion people are anemic worldwide with more than 100 million of these anemic children living in Africa. In Ethiopia, there is limited information about the prevalence and factors associated with anemia among HIV positive children. Thus, this study aimed to determine the prevalence and associated factors of anemia among HIV infected children aged 6 months to 14 years in Gondar university Hospital antiretroviral treatment clinic.

METHODS

A cross-sectional study was conducted on 265 HIV infected children from February to June 2013 on HIV infected children attending Gondar university Hospital ART clinic. The study subjects were selected with systematic random sampling technique. Data of socio demographic characteristics and clinical conditions of the study subjects was collected using a structured pretested questionnaire. Hemoglobin value and CD4 counts were determined by cell Dyne 1800 and FACS count machine respectively. WHO Cut off value of hemoglobin was taken and adjusted to altitude to define anemia. Data was analyzed by using the SPSS version 20 statistical software and bivariate and multivariate logistic regression was used to identify predictors.

RESULTS

Anemia was present in 16.2 % (43 /265) of children, 60.5 % of them had mild anemia, 37.2 % had moderate anemia and 2.3 % had severe anemia. About 46.5 % of anemic children had normocytic-normochromic anemia followed by macrocytic-normochromic anemia (39.5 %). In this study, anemia was associated with eating green leafy vegetables (OR = 0.43, 95 % CI (0.188-0.981) and being on cotrimoxazole treatment (OR = 2.169, 95 % CI (1.047-4.49). But there was no significant association with age, sex, WHO clinical stage, opportunistic infections, intestinal parasitic infection and CD4 count percentage.

CONCLUSIONS

The majority of HIV positive children in Northwest Ethiopia have a mild type of anemia and the increase in prevalence of anemia is due to being on cotrimoxazole and eating green leafy vegetables. Therefore, early diagnosis and treatment of anemia is essential in these patients.

Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012

OBJECTIVES

To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents.

DESIGN

Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain.

METHODS

Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL) were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation.

RESULTS

104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0)and viral load was 5.1 (4.6-5.6) log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104) was 64.5 months; second HAART (n = 56) 69.8 months; and third HAART (n = 21) 66.5 months. Eleven (11%) patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively). The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70).

CONCLUSIONS

Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.

Burden and Determinants of Severe Anemia among HIV-Infected Adults: Results from a Large Urban HIV Program in Tanzania, East Africa

BACKGROUND AND METHODS

This cross-sectional study aimed at determining the prevalence and risk factors for severe anemia, severe microcytic anemia, and severe normocytic anemia among HIV-infected individuals aged >15 years. Univariate and multivariate analyses were performed to identify the risk factors for anemia.

RESULTS

Data from 40 408 patients were analyzed, showing an overall prevalence of 22% for severe anemia. The risk of developing severe anemia increased by 49% among patients with a body mass index of <18.5 kg/m(2), by approximately 2-fold among patients with the World Health Organization (WHO) stage III, and by 3-fold among patients with WHO stage IV illness. Severe normocytic anemia was uniquely increased among patients aged ≥50 years, among those with chronic diarrhea and Kaposi's sarcoma, and those taking cotrimoxazole.

CONCLUSION

There was a high prevalence of severe anemia among adults infected with HIV. Focused identification of anemia should be based on the hemoglobin and mean corpuscular volume measurements.