1
|
Lang R, Coburn SB, Gill MJ, Justice AC, Grossman J, Gebo KA, Horberg MA, Mayor AM, Silverberg MJ, McGinnis KA, Hogan B, Moore RD, Althoff KN. Evaluation of mean corpuscular volume among anemic people with HIV in North America following ART initiation. AIDS Res Ther 2024; 21:52. [PMID: 39113038 PMCID: PMC11304803 DOI: 10.1186/s12981-024-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/25/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Anemia is common and associated with increased morbidity among people with HIV (PWH). Classification of anemia using the mean corpuscular volume (MCV) can help investigate the underlying causative factors of anemia. We characterize anemia using MCV among PWH receiving antiretroviral therapy (ART), and identify the risk factors for normocytic, macrocytic, and microcytic anemias. METHODS Including PWH with anemia (hemoglobin measure < 12.9 g/dL among men and < 11.9 g/dL among women) in the NA-ACCORD from 01/01/2007 to 12/31/2017, we estimated the annual distribution of normocytic (80-100 femtolitre (fL)), macrocytic (> 100 fL) or microcytic (< 80 fL) anemia based on the lowest hemoglobin within each year. Poisson regression models with robust variance and general estimating equations were used to estimate crude and adjusted prevalence ratios and 95% confidence intervals for risk factors for macrocytic (vs. normocytic) and microcytic (vs. normocytic) anemia stratified by sex. RESULTS Among 37,984 hemoglobin measurements that identified anemia in 14,590 PWH, 27,909 (74%) were normocytic, 4257 (11%) were microcytic, and 5818 (15%) were macrocytic. Of the anemic PWH included over the study period, 1910 (13%) experienced at least one measure of microcytic anemia and 3208 (22%) at least one measure of macrocytic anemia. Normocytic anemia was most common among both males and females, followed by microcytic among females and macrocytic among males. Over time, the proportion of anemic PWH who have macrocytosis decreased while microcytosis increased. Macrocytic (vs. normocytic) anemia is associated with increasing age and comorbidities. With increasing age, microcytic anemia decreased among females but not males. A greater proportion of PWH with normocytic anemia had CD4 counts ≤ 200 cells/mm3 and had recently initiated ART. CONCLUSION In anemic PWH, normocytic anemia was most common. Over time macrocytic anemia decreased, and microcytic anemia increased irrespective of sex. Normocytic anemia is often due to chronic disease and may explain the greater risk for normocytic anemia among those with lower CD4 counts or recent ART initiation. Identified risk factors for type-specific anemias including sex, age, comorbidities, and HIV factors, can help inform targeted investigation into the underlying causes.
Collapse
Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | | | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
Tendongfor N, Fokam J, Chenwi CA, Nwabo FLT, Nangmo A, Debimeh N, Moyo STN, Halle MP, Njom-Nlend AE, Ndombo PK, Ndjolo A. Determinants of survival of adolescents receiving antiretroviral therapy in the Centre Region of Cameroon: a multi-centered cohort-analysis. AIDS Res Ther 2023; 20:88. [PMID: 38098059 PMCID: PMC10722663 DOI: 10.1186/s12981-023-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND In spite of the global decreasing mortality associated with HIV, adolescents living with HIV (ADLHIV) in sub-Saharan Africa still experience about 50% mortality rate. We sought to evaluate survival rates and determinants of mortality amongst ADLHIV receiving antiretroviral therapy (ART) in urban and rural settings. METHODS A multi-centered, 10-year retrospective, cohort-study including ADLHIV on ART ≥ 6 months in the urban and rural settings of the Centre Region of Cameroon. Socio-demographic, clinical, biological, and therapeutic data were collected from files of ADLHIV. The Kaplan-Meier method was used to estimate survival probability after ART initiation; the log rank test used to compare survival curves between groups of variables; and the Cox proportional hazard model was used to identify the determinants of mortality. RESULTS A total of 403 adolescents' records were retained; 340 (84%) were from the urban and 63 (16%) from the rural settings. The female to male ratio was 7:5; mean age (Standard deviation) was 14.1 (2.6) years; at baseline, 64.4% were at WHO clinical stages I/II, 34.9% had ≥ 500 CD4 cells/mm3, 91.1% were anemic, and the median [Inter Quartile Range] duration on ART was5.3 [0.5-16] years. The survival rate at 1, 5 and 10 years on ART was respectively 97.0%, 55.9% and 8.7%; with mean survival time of 5.8 years (95% CI 5.5-6.1). In bivariate analysis, living in the rural setting, non-disclosed HIV status, baseline CD4 count < 500 cells/mm3, not being exposed to nevirapine prophylaxis at birth and being horizontally infected were found to be the determinants of higher mortality with poor retention in care slightly associated with mortality. In multivariate analysis, living in rural settings, poor retention in care and anemia were independent predictors of mortality (p < 0.05). CONCLUSION Although ADLHIV have good survival rate on ART after 1 year, we observe poor survival rates after 5 years and especially 10 years of treatment experience. Mitigating measures against poor survival should target those living in rural settings, anemic at baseline, or experiencing poor retention in care.
Collapse
Affiliation(s)
| | - Joseph Fokam
- Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Collins Ambe Chenwi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Fabrice Léo Tamhouo Nwabo
- Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
| | - Armanda Nangmo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
| | - Njume Debimeh
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Marie Patrice Halle
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Science, University of Douala, Douala, Cameroon
| | - Anne-Esther Njom-Nlend
- Pediatric Department, National Social Welfare Centre, Essos Health Centre, Yaoundé, Cameroon
- Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon
| | - Paul Koki Ndombo
- Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| |
Collapse
|
3
|
Ashenafi G, Tibebu M, Tilahun D, Tsegaye A. Immunohematological Outcome Among Adult HIV Patients Taking Highly Active Antiretroviral Therapy for at Least Six Months in Yabelo Hospital, Borana, Ethiopia. J Blood Med 2023; 14:543-554. [PMID: 37881654 PMCID: PMC10595970 DOI: 10.2147/jbm.s419414] [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: 05/17/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
Background Immunohematological abnormalities among human immunodeficiency virus-infected patients are common abnormalities associated with severe depletion of the immune system, covering a stage of acute syndrome to an advanced disease. The greatest impact was observed in the low- and middle-income countries. However, in Ethiopia, little attention has been paid, and only limited published information exists regarding immunohematological abnormalities among individuals receiving highly active antiretroviral treatment. Objective This study aimed to assess changes in immunological and hematological parameters in HIV-infected patients receiving HAART for at least six months at the antiretroviral therapy clinic of Yabelo Hospital, Borena, Ethiopia. Methods A cross-sectional study was conducted from February to July 2021 using convenient sampling to recruit 333 participants. Sociodemographic data and clinical characteristics were collected using a pretested questionnaire. Baseline data were extracted from medical records and after six month immunohematological measurements were performed on blood samples collected during the study period. Data analysis was performed using SPSS version 25. Descriptive analysis was performed, and the results are presented as numbers and percentages or means ± SD. A paired t-test was used to compare the mean values of the immunohematological parameters before and after six of taking HAART. Statistical significance was set at P < 0.05. Results The prevalence of anemia, leucopenia, neutropenia, lymphopenia and thrombocytopenia were 47.4%, 73.3%, 58.3%, 76.9% and 3.3% before initiation of HAART and 23.1%, 36.4%, 23.4%, 35.7% and 2.4% after initiation of HAART, respectively; Compared to baseline, there was also a significant decrease in the rate of Immunosuppression (CD4 < 350) from 62.2% at base line to 20.7% after HAART initiation. Conclusion Immunohematological profile of the patients improved after the initiation of HAART. The observation of large proportion of immunosuppressed individuals at baseline warrants advocating for HIV testing in the pastoralist community so that infected patients could benefit from early initiation of HAART.
Collapse
Affiliation(s)
- Girma Ashenafi
- Department of Medical Laboratory Sciences, Bule Hora University, Bule Hora, Oromia, Ethiopia
| | - Melatwork Tibebu
- Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dagnamyelew Tilahun
- Department of Medical Laboratory Sciences, Bule Hora University, Bule Hora, Oromia, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Tesfaye S, Hirigo M, Jember D, Shifeta M, Ketema W. Burden of Anemia among Human Immunodeficiency Virus-Positive Adults on Highly Active Antiretroviral Therapy at Hawassa University Compressive Specialized Hospital, Hawassa, Ethiopia. Anemia 2023; 2023:2170447. [PMID: 37868338 PMCID: PMC10590265 DOI: 10.1155/2023/2170447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/23/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
Background Anemia is the most common hematologic abnormality associated with human immunodeficiency virus (HIV)-infected patients and affects 60% to 80% of patients in late-stage disease. It has a considerable impact on the progression of HIV to advanced stages. This study aimed at assessing the burden of anemia in adult HIV-infected patients who are on highly active antiretroviral therapy (HAART) and have follow-up at Hawassa University Comprehensive Specialized Hospital (HUCSH) Antiretroviral therapy (ART) clinic. Methods A hospital-based retrospective study was conducted among HIV-positive adults on HAART at Hawassa University Compressive Specialized Hospital. The systematic sampling method was used to choose a total of 244 study participants. Data on demographic characteristics, related factors of anemia, latest hemoglobin, CD4, and ART regimens were collected using a structured data abstraction format. The data were cleaned and analyzed using SPSS version 21.0 after being manually checked for completeness. Multivariable logistic regression was carried out to detect elements associated with anemia. A P value of <0.05 was used as a cutoff point to announce statistical significance. Results The records of 244 patients were examined in total. Anemia was present in 29.9% (95% CI 23.8-35.2) among adult HIV patients. Female sex (AOR: 2.576, 95% (CI: 1.295-5.127)), having tuberculosis (TB) (AOR: 4.873, 95% (CI: 1.534-15.484)), taking a zidovudine (ZDV)-containing ART regimen (AOR: 5.216, 95% (CI: 1.239-21.962)), having clinical WHO stage IV and III diseases (AOR: 3.077, 95% CI (1.244-7.612)), having body mass index (BMI) <18.5 kg/m2 (AOR: 2.391, 95% (CI: 1.138-5.023)), and taking cotrimoxazole prophylaxis (AOR: 3.860 95% (CI: 1.097-13.576)) were substantially linked to the development of anemia among adult HIV patients. Conclusion and Recommendation. This study showed that anemia is still a problem among HIV patients on HAART. The burden of anemia was found to be high among patients with advanced WHO clinical stages, having a BMI less than 18.5 kg/m2, TB/HIV coinfection, being on AZT-based ART regimens, and taking cotrimoxazole preventive therapy (CPT). Consequently, it is suggested that early preventative interventions, such as serial hemoglobin follow-up, iron supplementation, and education about dietary consumption, be undertaken targeting the aforementioned groups. In addition, the preferred first-line ART regimen as per the latest national and WHO guidelines is recommended, especially for the above groups.
Collapse
Affiliation(s)
- Sisay Tesfaye
- Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Department of Internal Medicine, Hawassa, Ethiopia
| | - Melaku Hirigo
- Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Department of Internal Medicine, Hawassa, Ethiopia
| | - Dawit Jember
- Hawassa University, College of Medicine and Health Science, School of Public Health, Hawassa, Ethiopia
| | - Mekdes Shifeta
- Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Department of Pediatrics and Child Health, Hawassa, Ethiopia
| | - Worku Ketema
- Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Department of Pediatrics and Child Health, Hawassa, Ethiopia
| |
Collapse
|
6
|
Mugo C, Nduati R, Osoro E, Nyawanda BO, Mirieri H, Hunsperger E, Verani JR, Jin H, Mwaengo D, Maugo B, Machoki J, Otieno NA, Ombok C, Shabibi M, Okutoyi L, Kinuthia J, Widdowson MA, Njenga K, Inwani I, Wamalwa D. Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya. J Infect Dis 2022; 226:678-686. [PMID: 35403695 PMCID: PMC10155227 DOI: 10.1093/infdis/jiac128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. METHODS Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status. RESULTS Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth (<37 weeks), and 74/1317 (6%) had a low-birth-weight newborn (<2500 g). There was no evidence of associations between treated HIV infection and pregnancy loss (adjusted relative risk [aRR], 1.19; 95% confidence interval [CI], .65-2.16; P = .57), prematurity (aRR, 1.09; 95% CI, .70-1.70; P = .69), and low birth weight (aRR, 1.36; 95% CI, .77-2.40; P = .27). Factors associated with an HIV-positive status included older age, food insecurity, lower education level, higher parity, lower gestation at first antenatal clinic, anemia, and syphilis. Women who were overweight or underweight were less likely to be HIV infected compared to those with normal weight. CONCLUSIONS Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ruth Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Eric Osoro
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | | | - Harriet Mirieri
- Washington State University Global Health Kenya, Nairobi, Kenya
| | | | - Jennifer R Verani
- CDC-Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Hafsa Jin
- Coast Referral and Teaching Hospital, Mombasa, Kenya
| | - Dufton Mwaengo
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Brian Maugo
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - James Machoki
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | | | - Cynthia Ombok
- Washington State University Global Health Kenya, Nairobi, Kenya
| | | | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Marc Alain Widdowson
- CDC-Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Kariuki Njenga
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
7
|
Fiseha T, Ebrahim H. Prevalence and Predictors of Cytopenias in HIV-Infected Adults at Initiation of Antiretroviral Therapy in Mehal Meda Hospital, Central Ethiopia. J Blood Med 2022; 13:201-211. [PMID: 35502291 PMCID: PMC9056021 DOI: 10.2147/jbm.s355966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hematologic abnormalities are common complications of patients infected with HIV associated with accelerated deterioration in CD4+ cell counts, disease progression, poor quality of life and death. Few studies have evaluated the magnitude of cytopenias at the initiation of antiretroviral therapy (ART) in sub-Saharan Africa. The aim of this study was to determine the prevalence and predictors of cytopenias among HIV-infected adults at initiation of ART in a resource-limited setting in Ethiopia. Methods A cross-sectional study was conducted among HIV-infected adults initiating ART at the HIV care and treatment clinic of Mehal Meda Hospital between September 2008 and June 2019. Demographic, clinical and laboratory data of patients were collected from medical records. Anemia was defined according to WHO guidelines as hemoglobin concentration <12 g/dl for non-pregnant females and <13 g/dl for males. Leucopenia was defined as total white blood cell count <4.0 × 103 cells/μL and thrombocytopenia as platelet count <150 × 103 cells/μL. Logistic regression analysis was used to determine factors associated with the presence of cytopenias. Results Out of the total 566 patients included, 36.6% (95% CI 32.7–40.6%) had anemia, 17.1% (95% CI 14.2–20.4%) had leucopenia and 14.5% (95% CI 11.8–17.6%) had thrombocytopenia. A total of 53.2% (95% CI 49.1–57.3%) of patients had at least one form of cytopenia, 14.1% (95% CI 11.4–17.2%) had bicytopenia, and only 0.5% had pancytopenia. Factors associated with the presence of any cytopenia in multivariable analysis were male sex, advanced clinical disease stage, low CD4+ cell count, low BMI, and decreased renal function. Conclusion A substantial burden of cytopenias was detected among HIV-infected adults enrolled for care and treatment services in our setting. Patients with HIV infection should be screened for hematological abnormalities at initiation of ART because of its potential for morbidity and mortality during ART.
Collapse
Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Temesgen Fiseha, Email
| | - Hussen Ebrahim
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
8
|
Fentie Wendie T, Mengistu G. Prevalence and predictors of anemia among adults on highly active antiretroviral therapy in Northeast Ethiopia: A retrospective cohort study. PLoS One 2022; 17:e0265337. [PMID: 35333889 PMCID: PMC8956168 DOI: 10.1371/journal.pone.0265337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although antiretroviral therapy has significantly altered the natural history of human immunodeficiency virus infection and improved the quality of life of patients, there are conflicting reports regarding its impact on hematological outcomes. Thus, this study aimed at investigating the prevalence and predictors of anemia among adults on antiretroviral therapy in Northeast Ethiopia. Materials and methods A retrospective cohort study was carried out among adults who began antiretroviral treatment between September 2005 and January 2019 at two governmental hospitals in Dessie town. Data were collected from patients’ medical records using a pretested data extraction instrument. Anemia was the primary outcome variable of the study. It was defined based on WHO criteria after adjustment for altitude and smoking status of measured values. Data were entered and validated using EpiData Version 3.1 and then exported to SPSS Version 20.0 for analysis. Descriptive analysis was done for prevalence and binary logistic regression was carried out to assess whether covariates were associated with experiencing anemia. Statistical significance has been considered at p-value <0.05. Results Medical records of 392 patients (mean age: 35.58 ± 9.46 years) were reviewed. Of the total 392 patients, 218 (55.6%) were females, 261 (66.6%) were categorized under WHO clinical stage III/IV and 134 (34.2%) had a baseline CD4 cell count of <100 cells/mm3. The mean baseline CD4 cell count was 179 cells/mm3 (range: 2 to 853 cells) and 230 (58.7%) of the participants were on zidovudine-based regimen. Anemia was diagnosed among 162 (41.3%) patients. After adjustment for other confounding factors, risk of anemia was significantly associated with low baseline CD4 cell count (AOR 1.80, 95% CI 1.05–3.06) and tenofovir based regimen (AOR 2.05, 95% CI 1.31–3.21). On the other hand, being educated was found to be protective (AOR 0.40, 95% CI 0.21–0.78). Conclusion In this research, the prevalence of anemia was relatively high. Low baseline CD4 cell count and tenofovir based regimen were independent predictors of anemia; while being educated was protective. Treatment programs should focus on early diagnosis and treatment of HIV as well as routine screening and proper treatment of anemia.
Collapse
|
9
|
Moses SJ, Wachekwa I, Van Ryn C, Grandits G, Pau A, Badio M, Kennedy SB, Sneller MC, Higgs ES, Lane HC, Fallah M, Migueles SA, Reilly C. The impact of the 2014 Ebola epidemic on HIV disease burden and outcomes in Liberia West Africa. PLoS One 2021; 16:e0257049. [PMID: 34506540 PMCID: PMC8432817 DOI: 10.1371/journal.pone.0257049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Detailed longitudinal studies of HIV-positive individuals in West Africa are lacking. Here the HIV prevalence, incidence, all-cause mortality, and the proportion of individuals receiving treatment with cART in two cohorts of participants in Ebola-related studies are described. SETTING Individuals of all ages were enrolled and followed at four sites in the area of Monrovia, Liberia. METHODS Two cohorts identified in response to the Ebola epidemic are described to provide insights into the current state of the HIV epidemic. HIV testing was performed at baseline for participants in both cohorts and during follow-up in one cohort. RESULTS Prevalence and incidence of HIV (prevalence of 3.1% for women and 1.4% for men and incidence of 3.3 per 1,000) were higher in these cohorts compared to 2018 national estimates (prevalence of 1.3% and incidence of 0.39 per 1,000). Most participants testing positive did not know their status prior to testing. Of those who knew they were HIV positive, 7.9% reported being on antiretroviral treatment. The death rate among those with HIV was 12.3% compared to 1.9% in HIV-negative individuals (adjusted odds ratio of 6.87). While higher levels of d-dimer were associated with increased mortality, this was not specific to those with HIV, however lower hemoglobin levels were associated with increased mortality among those with HIV. CONCLUSION These findings point to a need to perform further research studies aimed at fulfilling these knowledge gaps and address current shortcomings in the provision of care for those living with HIV in Liberia.
Collapse
Affiliation(s)
- Soka J. Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Ian Wachekwa
- John F Kennedy Medical Center, Monrovia, Liberia
| | - Collin Van Ryn
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Greg Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alice Pau
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Moses Badio
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Stephen B. Kennedy
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Michael C. Sneller
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth S. Higgs
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - H. Clifford Lane
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| |
Collapse
|
10
|
Derangement of Liver Enzymes, Hyperglycemia, Anemia, and Associated Factors among HIV-Infected Patients Treated with Tenofovir Disoproxil Fumarate-Based Regimen in Ethiopia: A Prospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6613519. [PMID: 34222476 PMCID: PMC8221861 DOI: 10.1155/2021/6613519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 01/17/2023]
Abstract
Hepatotoxicity was found in different case reports and studies in tenofovir disoproxil fumarate- (TDF-) based regimen. However, there was no data regarding liver enzymes, glucose, and hemoglobin in Ethiopian patients receiving TDF-based regimen. The aim of this study was to determine elevated liver enzymes and its associated factors as well as elevated fasting plasma glucose and anemia. A hospital-based observational prospective cohort study was conducted on conveniently selected 63 patients in Tikur Anbessa Specialized Hospital (TASH) from January to September 2019. Laboratory values were determined at pre-TDF-based regimen baseline and six-month follow-up. The data was analyzed by using SPSS version 21.0, and multivariate logistic regression was used to determine associated factors with elevated liver enzymes. The overall elevated liver enzymes were found in 26 (41.3%) participants. From this, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) comprise 3 (4.8%), 3 (4.8%), and 20 (31.8%), respectively. Elevated fasting plasma glucose (FPG) was found in 9 (14.3%) and 14 (22.2%) of participants at baseline and six-month visit, respectively. At six-month visit, 4 (6.4%) of participants experienced anemia. The mean value of ALP and FPG at six months was significantly higher than their respective baseline mean values (mean difference (MD) = +63.38, 95% CI (39.84, 86.92), p = 0.0001; MD = +6.64, 95% CI (2.63, 10.64), p = 0.002, respectively). The mean value of ALT, AST, and Hg at six months was slightly increased compared to their respective baseline mean values, but the difference was not significant. In multivariate analysis, only female sex was significantly associated with elevated ALP (AOR = 4.5, 95% CI (1.03, 19.6), p = 0.045). Overall mild and moderate hepatotoxicity was found to be high (26, 41.3%) in the present study, and from this, the majority was comprised by elevated ALP (20, 31.8%). The proportion of participants with hyperglycemia was increased at the end of follow-up compared to its baseline value, but anemia was not. Female sex was significantly associated with elevated ALP. This study warrants monitoring of liver enzymes and glucose in TDF-based regimen.
Collapse
|
11
|
Duguma N, Tesfaye Kiya G, Adissu Maleko W, Bimerew LG. Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211020175. [PMID: 34104440 PMCID: PMC8165838 DOI: 10.1177/20503121211020175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives Hematological abnormalities of the major blood cell lines are frequently reported in patients with HIV-1 infection, in patients without antiretroviral therapy, and during the advanced stages of the disease. Chronic immune activation and inflammation results in the progressive depletion of CD4+ T-cells play a significant role in the clinical progression and pathogenesis of this infection. This study was aimed at assessing the prevalence of hematological abnormalities and their associated factors before and after the initiation of antiretroviral therapy in adults with HIV-1 infection in a referral hospital. Methods The study was conducted from 1 April to 30 June 2018, at Goba Referral Hospital. A total of 308 HIV-positive adults on treatment were enrolled during the study period. Socio-demographic and clinical data were collected using a structured questionnaire, with pre-highly active antiretroviral therapy data were extracted from medical records while post-treatment immuno-hematological measurements were done on blood samples collected at the time of enrollment. Results The prevalence of anemia, leukopenia, and thrombocytopenia before initiation of antiretroviral treatment was higher, although anemia and thrombocytopenia decreased correspondingly after initiation of treatment leukopenia increased by 4%. Mean values of immuno-hematological parameters before and after treatment initiation were significant (p < 0.05). CD4+ T-cell count <200 cells/µL was the only independent risk factor for anemia and leukopenia before highly active antiretroviral therapy, while stage IV disease, female sex, zidovudine, lamivudine, and nevirapine treatment, and intestinal parasite infection were predictors of anemia after treatment initiation. Conclusion The study revealed that hematological abnormalities are common in HIV infection, while the occurrence of abnormalities after highly active antiretroviral therapy initiation. Different risk factors are associated with hematological abnormalities at pre- and post-highly active antiretroviral therapy with regular monitoring of risk factors, adherence to the early initiation of highly active antiretroviral therapy, and conduct of further longitudinal studies are recommended.
Collapse
Affiliation(s)
- Negesso Duguma
- Department of Medical Laboratory Sciences, Madda Walabu University, Goba, Ethiopia
| | - Girum Tesfaye Kiya
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu Maleko
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Lealem Gedefaw Bimerew
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
12
|
Damtie S, Workineh L, Kiros T, Eyayu T, Tiruneh T. Hematological Abnormalities of Adult HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Treatment at Debre Tabor Comprehensive Specialized Hospital, Northcentral Ethiopia: A Cross-Sectional Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:477-484. [PMID: 33976573 PMCID: PMC8106447 DOI: 10.2147/hiv.s308422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Background Hematological abnormalities have been associated with an increased risk of disease progression and death in people living with human immunodeficiency virus (HIV). The use of antiretroviral medications can have a positive or negative effect on the hematological disorder. However, little is known about its impact on hematological parameters in antiretroviral-treated patients in Ethiopia, especially in the study area. Methods A cross-sectional study was conducted at Debre Tabor Comprehensive Specialized Hospital from September to November 2020. A total of 334 HIV-infected patients taking highly active antiretroviral treatment (HAART) at least for 6 months were selected using a simple random sampling technique. Socio-demographic and clinical characteristics of the study subjects were collected using a semi-structured questionnaire. Hematological and immunological parameters were determined using Sysmex kx-21 hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis was done using SPSS version 20 statistical software. A P-value <0.05 was considered statistically significant. Results A total of 334 HIV patients were included in this study. The prevalence of anemia, leucopenia, neutropenia, lymphopenia and thrombocytopenia were 37.1%, 22.8%, 8.4%, 10.5% and 17.1% before initiation of HAART and 17.4%, 34.2%, 18.8%, 13.1% and 8.3% after initiation of HAART, respectively. There was a significant difference in total white blood cell (WBC) count, absolute neutrophil count (ANC), red blood cell (RBC) count, hemoglobin value, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width (RDW), platelet and CD4+ T cell counts in HIV patients before and after initiation of HAART (P<0.05). Conclusion The most common hematological abnormalities observed in this study before and after HAART initiation were anemia, leucopenia, neutropenia, lymphopenia, and thrombocytopenia. However, after beginning HAART, the prevalence of anemia and thrombocytopenia decreased dramatically.
Collapse
Affiliation(s)
- Shewaneh Damtie
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Teklehaimanot Kiros
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| |
Collapse
|
13
|
Aryastuti SA, Dewi SR, Masyeni S. High Prevalence of Anemia among Human Immunodeficiency Virus-Infected Patients: A Cross-sectional Study in Bali-Indonesia. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2021; 14:329-334. [DOI: 10.13005/bpj/2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Anemia is a common condition found among Human Immunodeficiency Virus (HIV)-infected patients. T-cells that are infected with HIV virus can directly suppress the growth of progenitor cells in the bone marrow so that affecting the hemopoiesis resulted in anemia. These hematological abnormalities could potentially cause serious clinical implications. This study was conducted to determine the prevalence of anemia in HIV-infected patients in Bali. It was ahospital based cross-sectional studyconducted at two public hospital in Bali-Indonesia. A total of 243 medical record data from HIV-infected patients atWangaya Hospital Denpasar Bali and Sanjiwani Hospital Gianyar Bali between 2009 -2017 were included in analysis. Prevalence of anemia in antiretroviral (ART)-naïve patients and in patients on ART were 60.8% and 40.3%, respectively. Leucopenia and thrombocytopenia were found 8.2% and 9.4%, respectively, in ART-naïve group. While in patients with ART group leucopenia and thrombocytopenia were accounted for 6.9% and 4.3%, respectively. There was a significant difference in prevalence of anemia between ART-naïve patients and patients on ART (60.8% vs. 40.3%; p < 0.05). Although the prevalence of anemia was lower in patients on ART, but anemia continues to be common in a substantial portion of HIV-infected persons. Another studies are still needed to addressing the impact of anemia on HIV-infected individuals, as well as treatment strategies and future research directions.
Collapse
Affiliation(s)
- Sri Agung Aryastuti
- Department of Pharmacology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia,
| | - Sri Ratna Dewi
- 2Department of Clinical Pathology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia,
| | - Sri Masyeni
- Department of Microbilogy, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| |
Collapse
|
14
|
Vaswani PPM, Senga-Tang IR, Catapia JRM, Abad CLR, Dumagay TE. The hematologic profile of Filipino HIV-infected individuals and its association with CD4 counts. Hematol Transfus Cell Ther 2021; 44:307-313. [PMID: 33431267 PMCID: PMC9477755 DOI: 10.1016/j.htct.2020.10.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/05/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment. Methods This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count <200 cells/µL. Results The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count <200 cells/µL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count <200 cells/µL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment. Conclusion Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.
Collapse
Affiliation(s)
- Preeti Prerna M Vaswani
- Division of Hematology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines.
| | - Issa Rufina Senga-Tang
- Division of Infectious Diseases, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Jean Rachel M Catapia
- Division of Hematology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Cybele Lara R Abad
- Division of Infectious Diseases, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Teresita E Dumagay
- Division of Hematology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| |
Collapse
|
15
|
Berhane Y, Haile D, Tolessa T. Anemia in HIV/AIDS Patients on Antiretroviral Treatment at Ayder Specialized Hospital, Mekele, Ethiopia: A Case-Control Study. J Blood Med 2020; 11:379-387. [PMID: 33117024 PMCID: PMC7585826 DOI: 10.2147/jbm.s275467] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Human immunodeficiency virus and anemia are the major public health problems in Sub-Sahara Africa. Untreated anemia is associated with rapid progression and poor prognosis of the disease in HIV. This study was aimed at determining the magnitude, severity and associated factors of anemia among HIV infected patients taking zidovudine and tenofovir-containing first-line HAART in Ayder Comprehensive Specialized Hospital, Mekele, Ethiopia. Methods A case-control study was conducted from February to August 2019 using both convenient and quota sampling methods. Anemia is defined as hemoglobin value below 13 g/dl for male and below 12 g/dl for female. Sociodemographic and clinical characteristics were assessed using a structured questionnaire, medical records, electronic weighing scale, adult height board, automated hematology analyzer (Sysmex XT-4000i), and Becton Dickinson’s FACS caliber flow cytometer. Descriptive statistics, tables, graphs, Student’s t-test and l logistic regression were used to analyze the data. Results About one-third (33.5%) of study participants were found to be anemic (ZDV: 20.3%; TDF: 13.2%, and p<0.05). Among these anemic cases, the majority was found to have mild, and the remaining was moderate types. The most common form was normocytic-normochromic anemia (46.5%). Cotrimoxazole prophylaxis, poor adherence, advanced AIDS stage at baseline and underweight at baseline were the factors associated with anemia in patients taking zidovudine-containing regimen (p<0.05). Advanced stage at baseline, cotrimoxazole prophylaxis, poor adherence status and lack of regular income were significantly associated with anemia in patients taking tenofovir-containing regimen (p<0.05). Conclusion We find that the prevalence of anemia was significantly higher among patients taking ZDV-containing regimen. But different risk factors for anemia had been identified among ZDV-containing regimen, showing that appropriate follow-up, nutritional supplementation, continuous evaluation of patients on cotrimoxazole intake can reduce the risks of anemia in both types of regimens.
Collapse
Affiliation(s)
- Yemane Berhane
- Department of Biomedical Science, College of Medicine and Health Science, Adigrat University, Adigrat, Northern Ethiopia, Ethiopia
| | - Diresibachew Haile
- Department of Medical Physiology, School of Medicine, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Tolessa
- Department of Medical Physiology, School of Medicine, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Gebreweld A, Fiseha T, Girma N, Haileslasie H, Gebretsadik D. Prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia. PLoS One 2020; 15:e0239215. [PMID: 32931523 PMCID: PMC7491728 DOI: 10.1371/journal.pone.0239215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cytopenias affect the outcomes of highly active anti-retroviral therapy that results in higher morbidity, mortality, and impaired quality of life. The purpose of this study was to assess the prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia. METHOD A cross-sectional health facility based study was conducted among 499 consecutively selected adult HIV infected patients taking HAART for at least six months from January to April 2018. The study participant's socio-demographic and clinical information was collected using a pre-tested questionnaire and reviewing of medical records by trained clinical nurses. Complete blood count and CD4 T cell count were determined by Sysmex KX-21 N and BD FACS count respectively. Bivariate and multivariate analysis was performed to identify the independently associated factors of cytopenia and prevalence ratios and their 95% confidence intervals were estimated using Poisson regression model with robust error variance to quantify the strength of statistical association. In all cases, a P value less than 0.05 was considered statistically significant. RESULT Out of the total study participants, 39.9% had at least one form of cytopenia, 23.2% had anemia, 13.8% had leukopenia, 12.4% had thrombocytopenia, 11.62% had bi-cytopenias, and only 1% had pancytopenia. In multivariate analysis, cytopenia was independently associated with older age groups, male gender, ZDV based regimen, and CD4 count less than 200 cells/mm3. CONCLUSIONS In this study, the magnitude of any cytopenia was 40% among adult HIV infected patients taking highly active antiretroviral therapy and the prevalence increased as the CD4 count decreases. Therefore, these warrant the need for monitoring hematological parameters of HIV infected patients on HAART to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Angesom Gebreweld
- Department of Medical Laboratory Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Temesgen Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Nibret Girma
- Department of Laboratory, Mehal Meda Hospital, Mehal Meda, Ethiopia
| | - Haftay Haileslasie
- Department of Medical Laboratory Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
17
|
Mengistu A, Egata G, Hawulte B, Markos M, Lolaso T. Anemia and Associated Factors Among Adults with Human Immune Deficiency Virus on Antiretroviral Therapy in Public Health Facilities of Kembata Tembaro Zone, Southern Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2020; 12:341-349. [PMID: 32884360 PMCID: PMC7431452 DOI: 10.2147/hiv.s259259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Anemia is an independent prognostic marker of HIV/AIDS disease progression. It causes impaired physical functioning, psychological distress, poor quality-of-life, and reduces life expectancy in HIV patients. However, there is limited information in Ethiopia. Therefore, the aim of this study was to assess the magnitude of anemia and associated factors among adult HIV patients on antiretroviral therapy in public health facilities of Kembata Tembaro Zone, southern Ethiopia. METHODS We conducted a facility-based cross-sectional study. A total of 401 HIV patients attending antiretroviral therapy nested in five health facilities were included in the analysis. Simple random sampling was employed using medical record number to select study units. Data were collected using pretested and structured questionnaire, anthropometric measurements were taken, and a drop of capillary blood was collected to determine hemoglobin level by HemoCue 301 analyzer. Clinical related data were collected from patient medical records by using a structured checklist. The collected data were coded and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Logistic regression analysis was carried out to identify factors associated with anemia and statistical tests were declared significant at a P-value<0.05. RESULTS The magnitude of anemia among adults HIV patients attending ART was 26.2%, 95% CI=21.7-30.4. Being female (AOR=2.06, 95% CI=1.02-4.16), body mass index <18.5 Kg/m2 (AOR=2.28, 95% CI=1.09-4.78), Zidovudine use (AOR=3.71, 95% CI=1.9-7.26), having had an opportunistic infection (AOR=5.46, 95% CI=1.67-17.7), and WHO stage III or IV (AOR=5.71, 95% C=2.68-12.14) were significantly associated with the occurrence of anemia. CONCLUSION Anemia was found to be a moderate public health problem among ART attendants in the current study area. Thus, early detection and intervention targeting Zidovudine users, females, patients having body mass index <18.5 Kg/m2, patients having opportunistic infections, and patients having clinical WHO stage III or IV disease is vital to reduce the magnitude of anemia and its consequences.
Collapse
Affiliation(s)
- Abrham Mengistu
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Gudina Egata
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Melese Markos
- Department of Public Health, College of Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tsegaye Lolaso
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
18
|
Minchella PA, Adjé-Touré C, Zhang G, Tehe A, Hedje J, Rottinghaus ER, Natacha K, Diallo K, Ouedraogo GL, Nkengasong JN. Use of pre-ART laboratory screening to identify renal, hepatic and haematological abnormalities in Côte d'Ivoire. Trop Med Int Health 2020; 25:408-413. [PMID: 31960558 DOI: 10.1111/tmi.13364] [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: 11/28/2022]
Abstract
BACKGROUND High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification. METHODS We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d'Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT) and haemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate < 50 mL/min), hepatic abnormalities (ALT > 5× upper limit of normal) and severe anaemia (Hb < 6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question. RESULTS The prevalence of renal dysfunction, hepatic abnormalities and severe anaemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anaemia were age > 50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19-2.92; P < 0.001) and CD4 < 100 cells/µl (aOR: 2.57; 95% CI: 2.30-2.88; P < 0.001). CONCLUSION The relative infrequency of conditions linked to toxicity in Côte d'Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.
Collapse
Affiliation(s)
- P A Minchella
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C Adjé-Touré
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - G Zhang
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Tehe
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - J Hedje
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - E R Rottinghaus
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K Natacha
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - K Diallo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - G L Ouedraogo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - J N Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| |
Collapse
|
19
|
Ezeamama AE, Sikorskii A, Bajwa RK, Tuke R, Kyeyune RB, Fenton JI, Guwatudde D, Fawzi WW. Evolution of Anemia Types During Antiretroviral Therapy-Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults. Nutrients 2019; 11:nu11040755. [PMID: 30935133 PMCID: PMC6521252 DOI: 10.3390/nu11040755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022] Open
Abstract
This study examined whether the type of anemia in persons living with HIV/AIDS (PLWHA) changed from the beginning of highly antiretroviral therapy (HAART) and had implications for treatment outcomes and quality of life (QOL). If present, the anemia-type was defined as microcytic, macrocytic or anemia of chronic disease (ACD) at study months 0, 6, 12, and 18. Multinomial logistic regression quantified sociodemographic and HIV-treatment factors associated with incident microcytic anemia or ACD over 18 months. Repeated measures linear regression models estimated the anemia-type associated change in the CD4 cell-count, QOL, body mass index (BMI) and frailty over 18 months. Cox proportional hazard models estimated associations between anemia-type and time to (a) gain at least 100 CD4 cells/L and (b) hospitalization/death. Analyses were implemented in Statistical Analysis Software (v.9.4) from which odds ratios (ORs) mean differences (β) and corresponding 95% confidence intervals (CI) were estimated. At enrollment, ACD, macrocytic and microcytic anemia was present in 36.8% (n = 147), 11.3% (n = 45) and 9.5% (n = 38), respectively with 42% (n = 170) anemia-free. By the study end, only 23% (n = 115) were without anemia. Among the 251 with anemia at the study end, 53.3% (n = 195) had macrocytic anemia, 12.8% (n = 47) had ACD and 2.5% (n = 9) had microcytic anemia. Incident macrocytic anemia was positively associated with baseline hyperferritinemia (OR = 1.85, 95%CI: 1.03⁻3.32), inversely associated with wealth (OR = 0.87, 95%CI: 0.67⁻1.03) and inversely associated with efavirenz-containing HAART (OR = 0.42, 95%CI: 0.21⁻0.85). ACD incidence decreased by 53% (95%CI: 0.27⁻0.79) per 100 cells/L increase in baseline CD4-cell count and decreased by 90% (95%CI: 0.01,0.87) among adults treated with nevirapine-containing HAART. ACD was associated with a lower BMI at months 6 (β = -0.33, 95% CI: -0.64, -0.01) and 12 (β = -0.41, 95%CI: -0.73, -0.09), with lower QOL (β = -3.2, 95%CI: -5.94, -0.53) at month 12 and with elevated frailty (β = 1.2; 95%CI: 0.46, 1.86) at month 12. Macrocytic anemia did not predict a post-enrollment change in CD4, BMI or QOL during follow-up. However, the time to gain 100 CD4 cells/L was 43% slower (p < 0.05) and the frailty was higher at month 12 for PLWHA with the baseline or sustained macrocytic vs. no anemia. A substantial decline in ACD and microcytic anemia occurred in tandem with large increase in the macrocytic anemia over 18 months on HAART. Interventions to mitigate all anemia-particularly ACD, is expected to improve the immune recovery rate, lower frailty, and enhanced QOL.
Collapse
Affiliation(s)
- Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA.
| | - Ramanpreet K Bajwa
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Robert Tuke
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | | | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
| | - David Guwatudde
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7062 Kampala, Uganda.
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
| |
Collapse
|
20
|
Negesse A, Getaneh T, Temesgen H, Taddege T, Jara D, Abebaw Z. Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis. BMC HEMATOLOGY 2018; 18:32. [PMID: 30459953 PMCID: PMC6233542 DOI: 10.1186/s12878-018-0127-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023]
Abstract
Background Anemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level. Methods Studies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively. Result A total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M2 with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors. Conclusion This review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.
Collapse
Affiliation(s)
- Ayenew Negesse
- 1Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- 2Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- 1Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Tesfahun Taddege
- 3Ethiopia Field Epidemiology and Laboratory Training Program (EFELTP) Resident, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Dube Jara
- 4Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.,5School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zeleke Abebaw
- 6Department of Health Informatics, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| |
Collapse
|
21
|
Woldeamanuel GG, Wondimu DH. Prevalence of thrombocytopenia before and after initiation of HAART among HIV infected patients at black lion specialized hospital, Addis Ababa, Ethiopia: a cross sectional study. BMC HEMATOLOGY 2018; 18:9. [PMID: 29760930 PMCID: PMC5944097 DOI: 10.1186/s12878-018-0103-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022]
Abstract
Background Hematological abnormalities are common in HIV positive patients. Of these, thrombocytopenia is a known complication which has been associated with a variety of bleeding disorders. However, its magnitude and related factors have not been well-characterized in the era of highly active antiretroviral therapy (HAART) in Ethiopia. Therefore, this study aimed to assess the prevalence of thrombocytopenia before and after initiation of HAART among HIV positive patients attending Black Lion Specialized Hospital, Addis Ababa, Ethiopia. Methods A cross sectional study was conducted from February to April 2017 in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. A total of 176 patients on HAART were selected using simple random sampling techniques. Socio-demographic and clinical characteristics of the study patients were collected using structured questionnaire. Measurements of platelet counts and CD4 + T cell counts were made using Sysmex XT 2000i hematology analyzer and BD FACS Count CD4 analyzer, respectively. Statistical analysis of the data (Paired T- test and binary logistic regression) was done using SPSS version 20. P-value < 0.05 was considered as statistically significant. Results A total of 176 patients (Age > 18 years old) were enrolled in this study and had a mean age of 40.08 ± 9.38 years. There was significant increase in the mean values of platelet counts (218.44 ± 106.6 × 103/μl vs 273.65 ± 83.8 × 103/μl, p < 0.001) after six months of HAART initiation compared to the baseline. Prevalence of thrombocytopenia before and after HAART initiation was 25 and 5.7% respectively. HIV patients whose CD4 counts < 200 Cells/μl were more likely to have thrombocytopenia than HIV patients whose CD4 count ≥350 Cells/μl. However, it was not statistically associated with prevalence of thrombocytopenia. Conclusions This study has shown that the prevalence of thrombocytopenia after HAART initiation was decreased significantly. Based on our results, a number of study participants still had thrombocytopenia after initiation of HAART. Therefore, continuous screening for thrombocytopenia among HIV infected patients should be performed to decrease the risk of morbidity and mortality. Electronic supplementary material The online version of this article (10.1186/s12878-018-0103-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gashaw Garedew Woldeamanuel
- 1Department of Medicine, College of Medicine and Health Sciences, Wolkite University, Ethiopia, P.O. Box 07, Wolkite, Ethiopia
| | - Diresibachew Haile Wondimu
- 2Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia, Addis Ababa, Ethiopia
| |
Collapse
|