Jegede Feyisayo Ebenezer, Oyeyi Tinuade Ibijoke, Abdulrahman Surajudeen Abiola, Mbah Henry Akwen, Badru Titilope, Agbakwuru Chinedu, Adedokun Oluwasanmi
Family Health International-360 Plot 1073-A1 GODAB Plaza, Area 3 Garki-Abuja, Nigeria.
Biological Science Department, Bayero University, Kano, Nigeria.
PLoS One. 2017 Mar 27;12(3):e0174233. doi: 10.1371/journal.pone.0174233. eCollection 2017.
Human immunodeficiency virus (HIV) and malaria co-infection may present worse health outcomes in the tropics. Information on HIV/malaria co-infection effect on immune-hematological profiles is critical for patient care and there is a paucity of such data in Nigeria.
To evaluate immune-hematological profiles among HIV infected patients compared to HIV/malaria co-infected for ART management improvement.
This was a cross sectional study conducted at Infectious Disease Hospital, Kano. A total of 761 consenting adults attending ART clinic were randomly selected and recruited between June and December 2015. Participants' characteristics and clinical details including two previous CD4 counts were collected. Venous blood sample (4ml) was collected in EDTA tube for malaria parasite diagnosis by rapid test and confirmed with microscopy. Hematological profiles were analyzed by Sysmex XP-300 and CD4 count by Cyflow cytometry. Data was analyzed with SPSS 22.0 using Chi-Square test for association between HIV/malaria parasites co-infection with age groups, gender, ART, cotrimoxazole and usage of treated bed nets. Mean hematological profiles by HIV/malaria co-infection and HIV only were compared using independent t-test and mean CD4 count tested by mixed design repeated measures ANOVA. Statistical significant difference at probability of <0.05 was considered for all variables.
Of the 761 HIV infected, 64% were females, with a mean age of ± (SD) 37.30 (10.4) years. Prevalence of HIV/malaria co-infection was 27.7% with Plasmodium falciparum specie accounting for 99.1%. No statistical significant difference was observed between HIV/malaria co-infection in association to age (p = 0.498) and gender (p = 0.789). A significantly (p = 0.026) higher prevalence (35.2%) of co-infection was observed among non-ART patients compared to (26%) ART patients. Prevalence of co-infection was significantly lower (20.0%) among cotrimoxazole users compared to those not on cotrimoxazole (37%). The same significantly lower co-infection prevalence (22.5%) was observed among treated bed net users compared to those not using treated bed nets (42.9%) (p = 0.001). Out of 16 hematology profiles evaluated, six showed significant difference between the two groups (i) packed cell volume (p = <0.001), (ii) mean cell volume (p = 0.005), (iii) mean cell hemoglobin concentration (p = 0.011), (iv) absolute lymphocyte count (p = 0.022), (v) neutrophil percentage count (p = 0.020) and (vi) platelets distribution width (p = <0.001). Current mean CD4 count cell/μl (349±12) was significantly higher in HIV infected only compared to co-infected (306±17), (p = 0.035). A significantly lower mean CD4 count (234.6 ± 6.9) was observed among respondents on ART compared to non-ART (372.5 ± 13.2), p<0.001, mean difference = -137.9).
The study revealed a high burden of HIV and malaria co-infection among the studied population. Co-infection was significantly lower among patients who use treated bed nets as well as cotrimoxazole chemotherapy and ART. Six hematological indices differed significantly between the two groups. Malaria and HIV co-infection significantly reduces CD4 count. In general, to achieve better management of all HIV patients in this setting, diagnosing malaria, prompt antiretroviral therapy, monitoring CD4 and some hematology indices on regular basis is critical.
在热带地区，人类免疫缺陷病毒（HIV）与疟疾合并感染可能导致更糟糕的健康状况。了解HIV/疟疾合并感染对免疫血液学指标的影响对于患者护理至关重要，而尼日利亚缺乏此类数据。
评估HIV感染患者与HIV/疟疾合并感染患者的免疫血液学指标，以改善抗逆转录病毒治疗（ART）管理。
这是一项在卡诺传染病医院进行的横断面研究。2015年6月至12月期间，随机选取并招募了761名同意参与研究的成年ART门诊患者。收集了参与者的特征和临床细节，包括之前的两次CD4细胞计数。采集4ml静脉血样置于乙二胺四乙酸（EDTA）管中，通过快速检测诊断疟原虫，并通过显微镜检查进行确认。使用Sysmex XP - 300分析仪分析血液学指标，通过Cyflow流式细胞仪检测CD4细胞计数。使用SPSS 22.0软件进行数据分析，采用卡方检验分析HIV/疟原虫合并感染与年龄组、性别、ART、复方新诺明及使用经处理蚊帐之间的相关性。采用独立样本t检验比较HIV/疟疾合并感染组与单纯HIV感染组的平均血液学指标，采用混合设计重复测量方差分析检验平均CD4细胞计数。所有变量的统计学显著性差异以概率<0.05为标准。
在761名HIV感染者中，64%为女性，平均年龄为±（标准差）37.30（10.4）岁。HIV/疟疾合并感染率为27.7%，其中恶性疟原虫占99.1%。HIV/疟疾合并感染与年龄（p = 0.498）和性别（p = 0.789）之间未观察到统计学显著差异。与接受ART治疗的患者（26%）相比，未接受ART治疗的患者中合并感染率显著更高（35.2%）（p = 0.026）。与未使用复方新诺明的患者（37%）相比，使用复方新诺明的患者中合并感染率显著更低（20.0%）。与未使用经处理蚊帐的患者（42.9%）相比，使用经处理蚊帐的患者中合并感染率同样显著更低（22.5%）（p = 0.001）。在评估的16项血液学指标中，两组之间有6项指标存在显著差异：（i）红细胞压积（p = <0.001），（ii）平均红细胞体积（p = 0.005），（iii）平均红细胞血红蛋白浓度（p = 0.011），（iv）绝对淋巴细胞计数（p = 0.022），（v）中性粒细胞百分比计数（p = 0.020），（vi）血小板分布宽度（p = <0.001）。单纯HIV感染患者当前的平均CD4细胞计数/μl（349±12）显著高于合并感染患者（306±17）（p = 0.035）。与未接受ART治疗的患者（372.5±13.
