Duguma Negesso, Tesfaye Kiya Girum, Adissu Maleko Wondimagegn, Bimerew Lealem Gedefaw
Department of Medical Laboratory Sciences, Madda Walabu University, Goba, Ethiopia.
School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
SAGE Open Med. 2021 May 28;9:20503121211020175. doi: 10.1177/20503121211020175. eCollection 2021.
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.
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.
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 ( < 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.
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.
在未接受抗逆转录病毒治疗的HIV-1感染患者以及疾病晚期患者中，经常报告主要血细胞系的血液学异常情况。慢性免疫激活和炎症导致CD4+ T细胞逐渐耗竭，在这种感染的临床进展和发病机制中起重要作用。本研究旨在评估一家转诊医院中成人HIV-1感染者在开始抗逆转录病毒治疗前后血液学异常的患病率及其相关因素。
该研究于2018年4月1日至6月30日在戈巴转诊医院进行。在研究期间，共纳入308名接受治疗的HIV阳性成人。使用结构化问卷收集社会人口学和临床数据，从病历中提取高效抗逆转录病毒治疗前的数据，同时对入组时采集的血样进行治疗后免疫血液学测量。
抗逆转录病毒治疗开始前贫血、白细胞减少和血小板减少的患病率较高，尽管治疗开始后贫血和血小板减少相应下降，但白细胞减少增加了4%。治疗开始前后免疫血液学参数的平均值有显著差异（<0.05）。在高效抗逆转录病毒治疗前，CD4+ T细胞计数<200个细胞/微升是贫血和白细胞减少的唯一独立危险因素，而IV期疾病、女性、齐多夫定、拉米夫定和奈韦拉平治疗以及肠道寄生虫感染是治疗开始后贫血的预测因素。
该研究表明血液学异常在HIV感染中很常见，而在高效抗逆转录病毒治疗开始后异常情况仍会出现。高效抗逆转录病毒治疗前后血液学异常与不同的危险因素相关，建议定期监测危险因素，坚持尽早开始高效抗逆转录病毒治疗，并进行进一步的纵向研究。
