Prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia

Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China

This study aims to develop and evaluate a model to predict the immune reconstitution among HIV/AIDS patients after antiretroviral therapy (ART). A total of 502 HIV/AIDS patients are randomized to the training cohort and evaluation cohort. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis are performed to identify the indicators and establish the nomogram for predicting the immune reconstitution. Decision curve analysis (DCA) and clinical impact curve (CIC) are used to evaluate the clinical effectiveness of the nomogram. Predictive factors included white blood cells (WBC), baseline CD4+ T-cell counts (baseline CD4), ratio of effector regulatory T cells to resting regulatory T cells (eTreg/rTreg) and low-density lipoprotein cholesterol (LDL-C) and are incorporated into the nomogram. The area under the curve (AUC) is 0.812 (95% CI, 0.767∼0.851) and 0.794 (95%CI, 0.719∼0.857) in the training cohort and evaluation cohort, respectively. The calibration curve shows a high consistency between the predicted and actual observations. Moreover, DCA and CIC indicate that the nomogram has a superior net benefit in predicting poor immune reconstitution. A simple-to-use nomogram containing four routinely collected variables is developed and internally evaluated and can be used to predict the poor immune reconstitution in HIV/AIDS patients after ART.

Consequences of HIV infection in the bone marrow niche

Dysregulation of the bone marrow niche resulting from the direct and indirect effects of HIV infection contributes to haematological abnormalities observed in HIV patients. The bone marrow niche is a complex, multicellular environment which functions primarily in the maintenance of haematopoietic stem/progenitor cells (HSPCs). These adult stem cells are responsible for replacing blood and immune cells over the course of a lifetime. Cells of the bone marrow niche support HSPCs and help to orchestrate the quiescence, self-renewal and differentiation of HSPCs through chemical and molecular signals and cell-cell interactions. This narrative review discusses the HIV-associated dysregulation of the bone marrow niche, as well as the susceptibility of HSPCs to infection by HIV.

Global Prevalence and Associated Clinical Markers of Thrombocytopenia in People Living with HIV: Evidence from Meta-Analysis

Thrombocytopenia is one of the complications in human immunodeficiency virus (HIV) patients. To improve the health outcomes of patients living with HIV, it is important to understand the prevalence and pattern of associated key clinical markers globally. This meta-analysis, therefore, aimed to estimate the pooled prevalence of and associated clinical marker of thrombocytopenia globally. Methodology: The meta-analysis was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All statistical analyses were conducted using Stata. Twelve full-text papers out of 454 were eligible for meta-analysis. Results: Among 6686 participants, overall pooled prevalence of thrombocytopenia was 10.90% (95% CI: 7.91, 13.88) I2 = 93.62%. In addition, thrombocytopenia was more prevalent by 25.11% (95% CI: 13.33, 36.88) in patients with CD + T < 200 cells/μL, and less prevalent in patients with CD + T < 200 cells/μL 10.10% (95% CI: 7.37, 12.83), respectively. Conclusions and recommendations: This meta-analysis established the prevalence of thrombocytopenia among patients living with HIV, and that it may be more prevalent in patients with CD + T < 200 cells/μL indicating the necessity of routine screening for various haematological markers and a careful treatment plan for HIV patients.

Immuno-Haematological Abnormalities of HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Therapy in the Antiretroviral Therapy Clinics of Six Health Facilities at Dessie Town, Northeast Ethiopia

Background

In people living with the human immunodeficiency virus, haematological abnormalities have been linked to an increased risk of disease progression and mortality. Hematological parameters may have a positive or negative impact on antiretroviral therapy. The aim of this study was to assess the immuno-haematological abnormalities of HIV-infected patients before and after the initiation of highly active antiretroviral therapy in the antiretroviral therapy clinics of six health facilities in Dessie, Northeast Ethiopia.

Methods

A facility-based cross-sectional study was conducted from April to May 30, 2021, at the antiretroviral therapy clinics of six health facilities in Dessie Town. A total of 378 HIV-infected patients taking highly active antiretroviral treatment for at least 6 months by using a consecutive sampling technique were included. A well-organized questionnaire was used to collect socio-demographic and clinical information. Immune-haematological parameters were tested using a Mindray BS-300 hematology analyzer and a BD FACS count CD4 analyzer. Statistical analysis was performed using SPSS version 25 statistical software. Statistical significance was defined as a P-value of 0.05 with a 95% confidence interval.

Results

Leukopenia was found in 26.7% and 16.5%, neutropenia in 16.5% and 9.4%, lymphopenia in 20% and 3.1%, and thrombocytopenia in 25.9% and 7.1% of HIV patients before and after HAART initiation, respectively. There was a significant difference in total white blood cell, absolute neutrophil, red blood cell, hemoglobin value, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet and CD4+ T cell counts in HIV patients before and after the initiation of HAART with P < 0.05.

Conclusion and Recommendation

Anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia were the most common haematological abnormalities found in this study before and after HAART initiation. The prevalence of thrombocytopenia, immunosuppression, and viral load was reduced considerably after starting HAART.

The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Thrombocytopenia and leucopenia are frequently encountered hematological disorders among people living with HIV/AIDS. This systematic review and meta-analysis were aimed to indicate the national prevalence of thrombocytopenia and leucopenia among HIV/AIDS patients.

METHODS

This systematic review and meta-analysis was conducted following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A systematic search was conducted from February 01, 2021 to April 02, 2021 using electronic databases Google Scholar, PubMed, Web of Sciences, Google, EMBASE, SCOPUS and ResearchGate. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS) adapted for cross-sectional studies. Data analysis was done using STATA version 14 using metan commands. Random effect meta-analysis was used to estimate the pooled prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia.

RESULT

Of the 349 initially searched articles, 90 were assessed for eligibility and only 13 articles published from 2014 to 2020 were included in the final meta-analysis. A total of 3854 participants were involved in the included studies. The pooled prevalence of thrombocytopenia was 9.69% (95%CI; 7.40-11.97%). Significant heterogeneity was observed with I2 value of 84.7%. Thrombocytopenia was 11.91% and 5.95% prevalent among HAART naive and HAART exposed HIV/AIDS patients, respectively. The pooled prevalence of leucopenia among HIV/AIDS patients was 17.31% (95%CI: 12.37-22.25%).

CONCLUSION

This study showed a high prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS, indicating the necessity of regular screening of HIV seropositive patients for different hematological parameters and providing treatment.

Thrombocytopenia and Associated Factors Among HIV Infected Patients in Pre- and Post-Anti-Retroviral Therapy, North East Ethiopia

Background

Thrombocytopenia is a common disorder of HIV (human immunodeficiency virus) infection. The magnitude of thrombocytopenia and associated factors among HIV-infected patients receiving ART (anti-retroviral treatment) are not studied well in this study area. The aim of this study was to determine the prevalence of thrombocytopenia and associated factors in pre- and post-ART patients who attended Debre Berhan Referral Hospital (DBRH) in North-East Ethiopia.

Methods

A hospital-based cross-sectional study was conducted from October to December 2020 in DBRH, North-East Ethiopia. From the total ART patients, 272 study participants were selected randomly. Socio-demographic variables and clinical characteristics of the patients were collected by standard questionnaires. Measurement of platelet count and CD4 count were made by Sysmex XT2000i hematology machine and BD FACS count analyzer, respectively. Data were analyzed with SPSS software version 23 and multivariate logistic regression was done. P-value less than 0.05 was taken as statistically significant.

Results

The prevalence of thrombocytopenia was 22.7% with 95% CI: 17.8-27.5 in pre-ART and 14.7% with 95% CI: 11.0-19.9 in post-ART HIV-infected patients with a significant difference at P <0.0001. HIV patients with CD4 counts <200 cells/µL were more likely to have thrombocytopenia (35.0%) than patients with CD4 counts ≥200 with a P <0.04 in pre-ART patients. Patients on zidovudine (AZT)-based therapy were more likely to have thrombocytopenia (16.3%) than patients on tenofovir (TDF)-based therapy (14.8%) with P<0.79; however, this did not show any significant association.

Conclusion

The prevalence of thrombocytopenia decreased significantly after the beginning of ART. HIV patients with low CD4 count and on AZT-based treatment showed high risk of thrombocytopenia. According to this study, thrombocytopenic patients were observed even after the initiation of ART. As a result, to decrease thrombocytopenic associated mortality and morbidity, there should be continuous screening for HIV-infected patients.

Prevalence of Leucopenia and Associated Factors before and after Initiation of ART among HIV-Infected Patients, North East Ethiopia: Cross-Sectional Study

Background

Leucopenia is the commonest hematological abnormaly that occurs in patients with human immune deficiency virus (HIV) infection. The magnitude and related factors of leucopenia during the time of ART are not characterized in Ethiopia. This study aimed to assess the prevalence of leucopenia before and after the initiation of ART among HIV patients attending Debre Berhan Referral Hospital (DBRH), North East Ethiopia.

Methods

A cross-sectional study was conducted from September to December 2020 in DBRH, North-East Ethiopia. A total of 272 patients on ART were selected by simple random sampling techniques. Socio-demographic and clinical characteristics of the study participants were collected by standard questionnaires. Measurements of leucocyte count and CD4 counts were made by Sysmex XT 2000i hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis of data was done by SPSS version 23. Logistic regression was done and a P-value<0.05 was taken as statistically significant.

Results

The prevalence of leucopenia, neutropenia, and lymphopenia were 20.9%, 7.0%, and 6.6% before initiation of ART and 15.4%, 1.1, and 4.4% after initiation of ART, respectively. There was a significant difference in total white blood cell count, absolute neutrophil count, and total lymphocyte count between patients on ART and ART naïve patients. HIV patients whose cluster of differentiation (CD4) counts were <200 cells/µL and patients on a zidovudine (AZT)-based regimen were more likely to have leucopenia than HIV patients whose CD4 counts were ≥ 200 cells/µL and on a tenofovir (TDF)-based regimen.

Conclusion

In this study, the prevalence of leucopenia, neutropenia, and lymphopenia has shown a significant decrement after the initiation of ART. HIV patients with low CD4 count and on an AZT-based regimen are more likely to have leucopenia, neutropenia, and lymphopenia. Based on our findings, we recommend that the health care professional routinely investigate and should treat leucopenia.

The global prevalence of thrombocytopenia among HIV-infected adults: A systematic review and meta-analysis

BACKGROUND

Thrombocytopenia is the second most frequent complication of human immunodeficiency virus (HIV) infection, occurring in about 4-40% of HIV-infected patients. This study aimed to determine the global prevalence of thrombocytopenia among HIV/AIDS adults and its association with highly active antiretroviral therapy (HAART).

METHOD

This systematic review and meta-analysis was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Joana Brigg's Institute (JBI) critical appraisal checklist was used for quality appraisal of the included articles. A random-effect model was fitted to calculate the pooled estimates using STATA version-11. A sub-group analysis and sensitivity analysis were carried out to determine the potential source of heterogeneity.

RESULT

Of the 1823 articles that were retrieved, 20 full-text articles were eligible for meta-analysis. The overall pooled prevalence of thrombocytopenia among HIV-infected adults was 17.9% (95% CI: 14.69, 21.12) I² = 96.4%. The pooled prevalence of thrombocytopenia was 21.00% (95% CI: 17.35, 24.65) and 11.64% (95% CI: 6.66, 16.62), before and after initiation of HAART, respectively.

CONCLUSION

Thrombocytopenia is a common comorbidity in HIV patients and HAART was significantly associated with reduced thrombocytopenia. Therefore, prompt start of HAART might help to decrease the prevalence of thrombocytopenia and its subsequent complications.