埃塞俄比亚东北部HIV感染患者开始抗逆转录病毒治疗前后白细胞减少症的患病率及相关因素：横断面研究
Prevalence of Leucopenia and Associated Factors before and after Initiation of ART among HIV-Infected Patients, North East Ethiopia: Cross-Sectional Study.
作者信息
Talargia Feredegn, Teshome Yonas, Aynalem Yared Asmare, Asefa Adisu
机构信息
Department of Biomedical Science, College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia.
Department of Pediatrics Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia.
出版信息
J Blood Med. 2021 May 10;12:269-276. doi: 10.2147/JBM.S306369. eCollection 2021.
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 -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.
背景
白细胞减少是人类免疫缺陷病毒（HIV）感染患者中最常见的血液学异常。在埃塞俄比亚，抗逆转录病毒治疗（ART）期间白细胞减少的程度及相关因素尚无相关特征描述。本研究旨在评估埃塞俄比亚东北部德布雷伯汉转诊医院（DBRH）接受治疗的HIV患者在开始ART之前和之后白细胞减少的患病率。
方法
2020年9月至12月在埃塞俄比亚东北部的DBRH进行了一项横断面研究。通过简单随机抽样技术共选取了272例接受ART治疗的患者。通过标准问卷收集研究参与者的社会人口统计学和临床特征。白细胞计数和CD4计数分别通过Sysmex XT 2000i血液分析仪和BD FACS count CD4分析仪进行测量。数据的统计分析使用SPSS 23版软件。进行逻辑回归分析，P值<0.05被视为具有统计学意义。
结果
ART开始前白细胞减少、中性粒细胞减少和淋巴细胞减少的患病率分别为20.9%、7.0%和6.6%，ART开始后分别为15.4%、1.1%和4.4%。接受ART治疗的患者与未接受ART治疗的患者之间的总白细胞计数、绝对中性粒细胞计数和总淋巴细胞计数存在显著差异。分化簇（CD4）计数<200个细胞/微升的HIV患者以及接受基于齐多夫定（AZT）方案治疗的患者比CD4计数≥200个细胞/微升且接受替诺福韦（TDF）方案治疗的HIV患者更易出现白细胞减少。
结论
在本研究中，ART开始后白细胞减少、中性粒细胞减少和淋巴细胞减少的患病率显著下降。CD4计数低且接受基于AZT方案治疗的HIV患者更易出现白细胞减少、中性粒细胞减少和淋巴细胞减少。基于我们的研究结果，我们建议医护人员常规检查并治疗白细胞减少症。
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