Fiseha Temesgen, Ebrahim Hussen
Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
J Blood Med. 2022 Apr 26;13:201-211. doi: 10.2147/JBM.S355966. eCollection 2022.
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.
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 × 10 cells/μL and thrombocytopenia as platelet count <150 × 10 cells/μL. Logistic regression analysis was used to determine factors associated with the presence of cytopenias.
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.
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.
血液学异常是感染人类免疫缺陷病毒（HIV）患者常见的并发症，与CD4+细胞计数加速下降、疾病进展、生活质量差及死亡相关。在撒哈拉以南非洲地区，很少有研究评估抗逆转录病毒治疗（ART）开始时血细胞减少的程度。本研究的目的是确定在埃塞俄比亚资源有限的环境中，开始接受ART治疗的HIV感染成人中血细胞减少的患病率及预测因素。
2008年9月至2019年6月期间，在梅哈尔·梅达医院的HIV护理和治疗诊所对开始接受ART治疗的HIV感染成人进行了一项横断面研究。从病历中收集患者的人口统计学、临床和实验室数据。根据世界卫生组织的指南，贫血定义为非妊娠女性血红蛋白浓度<12 g/dl，男性<13 g/dl。白细胞减少症定义为白细胞总数<4.0×10⁹个细胞/μL，血小板减少症定义为血小板计数<150×10⁹个细胞/μL。采用逻辑回归分析确定与血细胞减少症存在相关的因素。
在纳入的566例患者中，36.6%（95%CI 32.7 - 40.6%）有贫血，17.1%（95%CI 14.2 - 20.4%）有白细胞减少症，14.5%（95%CI 11.8 - 17.6%）有血小板减少症。共有53.2%（95%CI 49.1 - 57.3%）的患者至少有一种血细胞减少症，14.1%（95%CI 11.4 - 17.2%）有双血细胞减少症，只有0.5%有全血细胞减少症。多变量分析中与任何血细胞减少症存在相关的因素包括男性、临床疾病晚期、CD4+细胞计数低、体重指数低和肾功能下降。
在我们的研究环境中，登记接受护理和治疗服务的HIV感染成人中检测到大量血细胞减少症负担。由于HIV感染患者在ART治疗期间有发病和死亡的可能性，因此在开始ART治疗时应筛查血液学异常。
