Prevalence and Predictors of Cytopenias in HIV-Infected Adults at Initiation of Antiretroviral Therapy in Mehal Meda Hospital, Central Ethiopia

Abstract

Background

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.

Methods

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 × 10³ cells/μL and thrombocytopenia as platelet count <150 × 10³ cells/μL. Logistic regression analysis was used to determine factors associated with the presence of cytopenias.

Results

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.

Conclusion

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.

Keywords:

• hematological abnormalities
• cytopenia
• HIV
• Ethiopia

Abbreviations

AIDS, acquired immunodeficiency syndrome; AOR, adjusted odds ratio; ART, antiretroviral therapy; BMI, body mass index; CD4, cluster of differentiation; CI, confidence interval; eGFR, estimated glomerular filtration rate; HIV, human immunodeficiency virus; IQR, inter quartile range; MDRD, modification of diet in renal disease; OR, odds ratio; SD, standard deviation; WHO, World Health Organization.

Data Sharing Statement

The data of this study cannot be shared publicly due to presence of sensitive (confidential) participants’ information and additional data than that used in this publication. But the data are available from the corresponding author on reasonable request.

Ethics and Consent Statement

Ethical approval of the protocol was achieved from the Institutional Review Board of College of Medicine and Health Sciences, Wollo University. As only routine data were analyzed, informed consent was not required; but patient’s identifiers were removed and only code numbers were used throughout the study. This study was conducted in accordance with the declaration of Helsinki.

Acknowledgments

The authors acknowledge the health staff at the Mehal Meda Hospital HIV care and treatment clinic for their assistance in gathering the data.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

The study did not receive any official funding.