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Huang L, Xie B, Zhang K, Xu Y, Su L, Lv Y, Lu Y, Qin J, Pang X, Qiu H, Li L, Wei X, Huang K, Meng Z, Hu Y, Lv J. Prediction of the risk of cytopenia in hospitalized HIV/AIDS patients using machine learning methods based on electronic medical records. Front Public Health 2023; 11:1184831. [PMID: 37575113 PMCID: PMC10416630 DOI: 10.3389/fpubh.2023.1184831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Cytopenia is a frequent complication among HIV-infected patients who require hospitalization. It can have a negative impact on the treatment outcomes for these patients. However, by leveraging machine learning techniques and electronic medical records, a predictive model can be developed to evaluate the risk of cytopenia during hospitalization in HIV patients. Such a model is crucial for designing a more individualized and evidence-based treatment strategy for HIV patients. Method The present study was conducted on HIV patients who were admitted to Guangxi Chest Hospital between June 2016 and October 2021. We extracted a total of 66 clinical features from the electronic medical records and employed them to train five machine learning prediction models (artificial neural network [ANN], adaptive boosting [AdaBoost], k-nearest neighbour [KNN] and support vector machine [SVM], decision tree [DT]). The models were tested using 20% of the data. The performance of the models was evaluated using indicators such as the area under the receiver operating characteristic curve (AUC). The best predictive models were interpreted using the shapley additive explanation (SHAP). Result The ANN models have better predictive power. According to the SHAP interpretation of the ANN model, hypoproteinemia and cancer were the most important predictive features of cytopenia in HIV hospitalized patients. Meanwhile, the lower hemoglobin-to-RDW ratio (HGB/RDW), low-density lipoprotein cholesterol (LDL-C) levels, CD4+ T cell counts, and creatinine clearance (Ccr) levels increase the risk of cytopenia in HIV hospitalized patients. Conclusion The present study constructed a risk prediction model for cytopenia in HIV patients during hospitalization with machine learning and electronic medical record information. The prediction model is important for the rational management of HIV hospitalized patients and the personalized treatment plan setting.
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Affiliation(s)
- Liling Huang
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Bo Xie
- School of Information and Management, Guangxi Medical University, Nanning, Guangxi, China
| | - Kai Zhang
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Yuanlong Xu
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Lingsong Su
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Yu Lv
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Yangjie Lu
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Jianqiu Qin
- Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Xianwu Pang
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Hong Qiu
- Institute of Life Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Lanxiang Li
- Basic Medical College of Guangxi Medical University, Nanning, Guangxi, China
| | - Xihua Wei
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Kui Huang
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Zhihao Meng
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Yanling Hu
- School of Information and Management, Guangxi Medical University, Nanning, Guangxi, China
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
- Institute of Life Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiannan Lv
- Guangxi Clinical Center for AIDS Prevention and Treatment, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
- Department of Infection, Affiliated Hospital of the Youjiang Medical University for Nationalities, Baise, Guangxi, China
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Lubega J, Kim TO, Airewele G, Grimes A, Bulsara S, Peckham E, Wanless SR, Haq H, Elyanu P, Musoke P, Lumumba M, Kekitiinwa A, Matshaba M, Scheurer M, Despotovic J. Risk factors and prognostic significance of platelet count abnormalities in children with HIV infection on antiretroviral therapy. AIDS 2023; 37:413-421. [PMID: 36129118 PMCID: PMC9877116 DOI: 10.1097/qad.0000000000003387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH). DESIGN A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014. METHODS Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival. RESULTS Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival. CONCLUSIONS Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.
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Affiliation(s)
- Joseph Lubega
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Taylor O Kim
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Amanda Grimes
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Shaun Bulsara
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Erin Peckham
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Heather Haq
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | | | | | | | | | - Michael Scheurer
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Jenny Despotovic
- Baylor College of Medicine, Houston, Texas, 77030, United States
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Coagulation Parameters in Human Immunodeficiency Virus Infected Patients: A Systematic Review and Meta-Analysis. AIDS Res Treat 2022; 2022:6782595. [PMID: 35492260 PMCID: PMC9050251 DOI: 10.1155/2022/6782595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coagulation abnormalities are common complications of human immunodeficiency virus (HIV) infection. Highly active antiretroviral treatment (HAART) decreased the mortality of HIV but increased coagulopathies. HIV-related thrombocytopenia, prolonged prothrombin time (PT), activated partial thromboplastin time (APTT), and high D-dimer level commonly manifested in patients with HIV. Thus, this study is aimed to compare coagulation parameters of HAART-treated and HAART-naïve HIV-infected patients with HIV-seronegative controls. Methods A systematic literature search was conducted using the databases PubMed/MEDLINE, Embase, Web of Science, and Google Scholar of studies published until July 2021. The primary outcome of interest was determining the pooled mean difference of coagulation parameters between HIV-infected patients and seronegative controls. The Joana Briggs Institute (JBI) critical appraisal tool was used for quality appraisal. Statistical analyses were performed using Stata11.0 software. The statistical results were expressed as the effect measured by standardized mean difference (SMD) with their related 95% confidence interval (CI). Results A total of 7,498 participants (1,144 HAART-naïve patients and 2,270 HAART-treated HIV-infected patients and 3,584 HIV-seronegative controls) from 18 studies were included. HIV-infected patients (both on HAART and HAART-naive) exhibited significantly higher levels of PT than HIV-seronegative controls (SMD = 0.66; 95% CI: 0.53–0.80 and SMD = 1.13; 95% CI: 0.60–2.0, respectively). The value of APTT was significantly higher in patients with HIV on HAART than in seronegative controls. However, the values of PLT count, APTT, and fibrinogen level were significantly higher in seronegative controls. Besides, the level of fibrinogen was significantly higher in HAART-treated than treatment-naïve patients (SMD = 0.32; 95%CI: 0.08, 0.57). Moreover, the level of APTT and PT had no statistical difference between HAART and HAART-naïve HIV-infected patients. Conclusions This study identified that HIV-infected patients are more likely to develop coagulation abnormalities than HIV-seronegative controls. Therefore, coagulation parameters should be assessed regularly to prevent and monitor coagulation disorders in HIV-infected patients.
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Fiseha T, Ebrahim H. Prevalence and Predictors of Cytopenias in HIV-Infected Adults at Initiation of Antiretroviral Therapy in Mehal Meda Hospital, Central Ethiopia. J Blood Med 2022; 13:201-211. [PMID: 35502291 PMCID: PMC9056021 DOI: 10.2147/jbm.s355966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Correspondence: Temesgen Fiseha, Email
| | - Hussen Ebrahim
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Getaneh Z, Wale W, Chanie B, Temesgen E, Abebe M, Walie M, Lemma M. Magnitude and associated factors of anemia among AZT based HAART experienced adult HIV patients at University of Gondar Comprehensive Specialized Referral Hospital, Northwest, Ethiopia, 2019: a retrospective cohort study. BMC Infect Dis 2021; 21:1016. [PMID: 34583644 PMCID: PMC8480035 DOI: 10.1186/s12879-021-06712-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Anemia is the most common hematologic abnormalities in AIDS patients usually associated with disease progression and poor clinical outcomes. Zidovudine (AZT), which is one of the nucleoside reverse transcriptase inhibitor drug families of the first line antiretroviral therapy regimen for HIV/AIDS patients, causes anemia due to early long-term of higher-dose therapy. This study was aimed to assess the magnitude and associated factors of anemia among AZT containing HAART experienced adult HIV/ADIS patients at University of Gondar Comprehensive Specialized Referral Hospital, northwest, Ethiopia, 2019. Methods A retrospective cohort study was conducted among a total of 320 adult AZT based HAART experienced HIV/AIDS patients from January 2016 to December 2018. Systematic random sampling technique was used to select the patients’ charts. All required data for this study were extracted from patients’ medical charts. Data were coded, cleared and entered into Epi Info version 3.5.3, and transformed to SPSS version 20 for analysis. Descriptive statistics, bivariable and multivariable logistic regression models were fitted to identify associated factors of anemia and P-value < 0.05 was considered as statistically significance. Results A total of 320 adult AZT based HAART experienced HIV/AIDS patients’ charts were assessed. Of the total patients, 198 (61.9%) were females and 133 (41.6%) were within the age range of 35–45 years. More than half, 237(76.9%) of the patients were from the urban area and 186 (58.1%) were on WHO clinical stage III at the baseline. The prevalence of anemia was 50% (95% CI 44.7–55.0%), 44.1% (95% CI 38.4–50.0%), 35.6% (95% CI 30.3–40.6%), 40% (95% CI 34.4–45.6%), 40.6% (95% CI 35.0–46.3) and 39.1% (95% CI 33.4–44.1%) at baseline, 6 months, 12 months, 18 months, 24 months and 30 months of follow-up period, respectively. The overall prevalence of anemia was 41.6%. Anemia had significant association with WHO clinical stage and base line Hgb values. Conclusions A significant number of participants were anemic in this study. WHO clinical stage and baseline Hgb value were the contributing factors for anemia among these patients. Therefore, anemia needs an immediate intervention on associated factor to improve the anemic status and living condition of HIV patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06712-5.
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Affiliation(s)
- Zegeye Getaneh
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Worku Wale
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar Hospital, Gondar, Ethiopia
| | - Belete Chanie
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar Hospital, Gondar, Ethiopia
| | - Etetetu Temesgen
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar Hospital, Gondar, Ethiopia
| | - Metadele Abebe
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar Hospital, Gondar, Ethiopia
| | - Melesse Walie
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar Hospital, Gondar, Ethiopia
| | - Mulualem Lemma
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bisetegn H, Ebrahim H. The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0257630. [PMID: 34543340 PMCID: PMC8452017 DOI: 10.1371/journal.pone.0257630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Thrombocytopenia and leucopenia are frequently encountered hematological disorders among people living with HIV/AIDS. This systematic review and meta-analysis were aimed to indicate the national prevalence of thrombocytopenia and leucopenia among HIV/AIDS patients. METHODS This systematic review and meta-analysis was conducted following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A systematic search was conducted from February 01, 2021 to April 02, 2021 using electronic databases Google Scholar, PubMed, Web of Sciences, Google, EMBASE, SCOPUS and ResearchGate. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS) adapted for cross-sectional studies. Data analysis was done using STATA version 14 using metan commands. Random effect meta-analysis was used to estimate the pooled prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia. RESULT Of the 349 initially searched articles, 90 were assessed for eligibility and only 13 articles published from 2014 to 2020 were included in the final meta-analysis. A total of 3854 participants were involved in the included studies. The pooled prevalence of thrombocytopenia was 9.69% (95%CI; 7.40-11.97%). Significant heterogeneity was observed with I2 value of 84.7%. Thrombocytopenia was 11.91% and 5.95% prevalent among HAART naive and HAART exposed HIV/AIDS patients, respectively. The pooled prevalence of leucopenia among HIV/AIDS patients was 17.31% (95%CI: 12.37-22.25%). CONCLUSION This study showed a high prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS, indicating the necessity of regular screening of HIV seropositive patients for different hematological parameters and providing treatment.
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Affiliation(s)
- Habtye Bisetegn
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussien Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Duguma N, Tesfaye Kiya G, Adissu Maleko W, Bimerew LG. Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211020175. [PMID: 34104440 PMCID: PMC8165838 DOI: 10.1177/20503121211020175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives 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. Methods 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. Results 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 (p < 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. Conclusion 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.
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Affiliation(s)
- Negesso Duguma
- Department of Medical Laboratory Sciences, Madda Walabu University, Goba, Ethiopia
| | - Girum Tesfaye Kiya
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu Maleko
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Lealem Gedefaw Bimerew
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Rajme-Lopez S, Crabtree-Ramírez B, Acosta-Medina AA, Olivas-Martínez A, Bourlon C. HIV-positive patients presenting with peripheral blood cytopenias: is bone marrow assessment a priority? Hematol Transfus Cell Ther 2021; 44:542-548. [PMID: 34312113 PMCID: PMC9605914 DOI: 10.1016/j.htct.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 02/18/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Hematologic abnormalities are frequent among persons living with HIV (PLWH). The bone marrow aspirate (BMA) and biopsy (BMB) are commonly performed in the diagnostic approach of patients with unexplained cytopenias. Changes in antiretrovirals, supportive therapy and increased life expectancy have modified the distribution and etiology of cytopenias, questioning their use. Our aim was to analyze the diagnostic yield of BMA, BMB and marrow cultures for the evaluation of cytopenias in PLWH. Methods This was a retrospective cohort of ≥ 18-year-old PLWH undergoing bone marrow assessment (MA) for the evaluation of cytopenias between January 2002 and December 2015. Results A total of 236 cytopenic events were analyzed, 47.9% being PLWH who had a longstanding diagnosis (≥ 1 year). Adherence to antiretrovirals was 63.5%. Anemia was seen in 91.9% and pancytopenia in 39%. Common presentations included fever (52.1%), weight loss (42.8%) and adenopathies (28.8%). Median days from detection to MA was 5 (0 – 63 days). Most common etiologies were non-HIV infectious diseases (31.4%) and benign/malignant hematologic diseases (26.3%). The diagnostic yield was 16.1% for BMA, 20.3% for BMB, 30.5% for both and 35.6% when cultures were added. Patients most likely to have conclusive MA were those with moderate/severe thrombocytopenia (p = 0.007). Fever, splenomegaly, and low CD4+ counts were associated with infectious etiologies, while hematologic diagnoses were related to the presence of adenopathies. Conclusion As a minimally invasive intervention, the MA has a high yield for identifying the etiology of cytopenic events in PLWH, being conclusive in one in three patients. Early performance could lead to prompt diagnosis and timely therapy initiation.
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Affiliation(s)
- Sandra Rajme-Lopez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Aldo A Acosta-Medina
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Christianne Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Damtie S, Workineh L, Kiros T, Eyayu T, Tiruneh T. Hematological Abnormalities of Adult HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Treatment at Debre Tabor Comprehensive Specialized Hospital, Northcentral Ethiopia: A Cross-Sectional Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:477-484. [PMID: 33976573 PMCID: PMC8106447 DOI: 10.2147/hiv.s308422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Background Hematological abnormalities have been associated with an increased risk of disease progression and death in people living with human immunodeficiency virus (HIV). The use of antiretroviral medications can have a positive or negative effect on the hematological disorder. However, little is known about its impact on hematological parameters in antiretroviral-treated patients in Ethiopia, especially in the study area. Methods A cross-sectional study was conducted at Debre Tabor Comprehensive Specialized Hospital from September to November 2020. A total of 334 HIV-infected patients taking highly active antiretroviral treatment (HAART) at least for 6 months were selected using a simple random sampling technique. Socio-demographic and clinical characteristics of the study subjects were collected using a semi-structured questionnaire. Hematological and immunological parameters were determined using Sysmex kx-21 hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis was done using SPSS version 20 statistical software. A P-value <0.05 was considered statistically significant. Results A total of 334 HIV patients were included in this study. The prevalence of anemia, leucopenia, neutropenia, lymphopenia and thrombocytopenia were 37.1%, 22.8%, 8.4%, 10.5% and 17.1% before initiation of HAART and 17.4%, 34.2%, 18.8%, 13.1% and 8.3% after initiation of HAART, respectively. There was a significant difference in total white blood cell (WBC) count, absolute neutrophil count (ANC), red blood cell (RBC) count, hemoglobin value, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width (RDW), platelet and CD4+ T cell counts in HIV patients before and after initiation of HAART (P<0.05). Conclusion The most common hematological abnormalities observed in this study before and after HAART initiation were anemia, leucopenia, neutropenia, lymphopenia, and thrombocytopenia. However, after beginning HAART, the prevalence of anemia and thrombocytopenia decreased dramatically.
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Affiliation(s)
- Shewaneh Damtie
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Lemma Workineh
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Teklehaimanot Kiros
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Medical Laboratory Science, Debre Tabor, Ethiopia
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A Noninvasive Prediction Model for Hepatitis B Virus Disease in Patients with HIV: Based on the Population of Jiangsu, China. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6696041. [PMID: 33860053 PMCID: PMC8024075 DOI: 10.1155/2021/6696041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Objective To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China. Methods A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant P value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm. Results AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: accuracy = 0.928, precision = 0.915, recall = 0.944, F − 1 = 0.930, and AUC = 0.96; heterosexual transmission group: accuracy = 0.892, precision = 0.881, recall = 0.905, F − 1 = 0.893, and AUC = 0.98). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity. Conclusions The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings.
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Getawa S, Aynalem M, Bayleyegn B, Adane T. The global prevalence of thrombocytopenia among HIV-infected adults: A systematic review and meta-analysis. Int J Infect Dis 2021; 105:495-504. [PMID: 33684556 DOI: 10.1016/j.ijid.2021.02.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Thrombocytopenia is the second most frequent complication of human immunodeficiency virus (HIV) infection, occurring in about 4-40% of HIV-infected patients. This study aimed to determine the global prevalence of thrombocytopenia among HIV/AIDS adults and its association with highly active antiretroviral therapy (HAART). METHOD This systematic review and meta-analysis was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Joana Brigg's Institute (JBI) critical appraisal checklist was used for quality appraisal of the included articles. A random-effect model was fitted to calculate the pooled estimates using STATA version-11. A sub-group analysis and sensitivity analysis were carried out to determine the potential source of heterogeneity. RESULT Of the 1823 articles that were retrieved, 20 full-text articles were eligible for meta-analysis. The overall pooled prevalence of thrombocytopenia among HIV-infected adults was 17.9% (95% CI: 14.69, 21.12) I2 = 96.4%. The pooled prevalence of thrombocytopenia was 21.00% (95% CI: 17.35, 24.65) and 11.64% (95% CI: 6.66, 16.62), before and after initiation of HAART, respectively. CONCLUSION Thrombocytopenia is a common comorbidity in HIV patients and HAART was significantly associated with reduced thrombocytopenia. Therefore, prompt start of HAART might help to decrease the prevalence of thrombocytopenia and its subsequent complications.
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Affiliation(s)
- Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Gebreweld A, Fiseha T, Girma N, Haileslasie H, Gebretsadik D. Prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia. PLoS One 2020; 15:e0239215. [PMID: 32931523 PMCID: PMC7491728 DOI: 10.1371/journal.pone.0239215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cytopenias affect the outcomes of highly active anti-retroviral therapy that results in higher morbidity, mortality, and impaired quality of life. The purpose of this study was to assess the prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia. METHOD A cross-sectional health facility based study was conducted among 499 consecutively selected adult HIV infected patients taking HAART for at least six months from January to April 2018. The study participant's socio-demographic and clinical information was collected using a pre-tested questionnaire and reviewing of medical records by trained clinical nurses. Complete blood count and CD4 T cell count were determined by Sysmex KX-21 N and BD FACS count respectively. Bivariate and multivariate analysis was performed to identify the independently associated factors of cytopenia and prevalence ratios and their 95% confidence intervals were estimated using Poisson regression model with robust error variance to quantify the strength of statistical association. In all cases, a P value less than 0.05 was considered statistically significant. RESULT Out of the total study participants, 39.9% had at least one form of cytopenia, 23.2% had anemia, 13.8% had leukopenia, 12.4% had thrombocytopenia, 11.62% had bi-cytopenias, and only 1% had pancytopenia. In multivariate analysis, cytopenia was independently associated with older age groups, male gender, ZDV based regimen, and CD4 count less than 200 cells/mm3. CONCLUSIONS In this study, the magnitude of any cytopenia was 40% among adult HIV infected patients taking highly active antiretroviral therapy and the prevalence increased as the CD4 count decreases. Therefore, these warrant the need for monitoring hematological parameters of HIV infected patients on HAART to reduce morbidity and mortality.
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Affiliation(s)
- Angesom Gebreweld
- Department of Medical Laboratory Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Temesgen Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Nibret Girma
- Department of Laboratory, Mehal Meda Hospital, Mehal Meda, Ethiopia
| | - Haftay Haileslasie
- Department of Medical Laboratory Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Suja S, Saravanan T, Karthikeyan S. Profile of hematological abnormalities and its correlation with absolute CD4 count and human immunodeficiency virus viral load in human immunodeficiency virus-infected patients in a tertiary care hospital. Indian J Sex Transm Dis AIDS 2020; 41:156-161. [PMID: 33817587 PMCID: PMC8000667 DOI: 10.4103/ijstd.ijstd_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/28/2019] [Accepted: 12/22/2019] [Indexed: 11/04/2022] Open
Abstract
Background A variety of hematological manifestations are seen at every stage of human immunodeficiency virus (HIV) infection, and they often pose a great challenge in the comprehensive management of acquired immunodeficiency syndrome. Anemia is the most common hematological abnormality associated with HIV infection. The severity and the incidence of cytopenia are usually correlated with the stage of the disease and underlying immune status if interpreted cautiously, especially if the patient is on regular follow-up. The primary objective of the present study was to understand the spectrum of hematological abnormalities in HIV-infected patients, whereas the secondary objective was to evaluate the correlation of hematological abnormalities with absolute CD4 count and HIV viral load. Materials and Methods The present cross-sectional descriptive study was conducted on 100 patients, aged 18 years and above, diagnosed with HIV infection and confirmed by Western blot or ELISA method. Both inpatients and outpatients at our tertiary care hospital were included in the study. Results Individuals with high viral load and low CD4 count had a higher prevalence of anemia. There was a statistically significant and directly proportionate decrease in the absolute CD4 count as the hemoglobin levels decreased (P = 0.004). In the present study, normocytic normochromic blood picture and anemia of chronic disease blood picture were more prevalent among the study participants. Individuals with high viral load and CD4 count <200 cells/mm3 had a higher rate of occurrence of coinfections. The correlation of absolute neutrophil count and thrombocytopenia with absolute CD4 count and HIV viral load was not statistically significant. Conclusions Complete blood counts and peripheral smear observations were significantly correlated with high HIV viral load and lower absolute CD4 cell counts and therefore can be suggested as economical alternatives for the evaluation of the status of HIV disease stage and its progression.
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Affiliation(s)
- S Suja
- Department of General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - T Saravanan
- Department of General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - S Karthikeyan
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Zenebe WA, Anbese AT, Tesfaye TS. Anemia And Associated Factors Among Adult People Living With HIV/AIDS Receiving Anti-Retroviral Therapy At Gedeo Zone, SNNPR, Ethiopia, 2018. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 11:351-356. [PMID: 31908543 PMCID: PMC6927561 DOI: 10.2147/hiv.s220461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022]
Abstract
Background Anemia is one of the most common blood abnormalities in people with HIV. The incidence of anemia ranges from 10% in people who have no HIV symptoms to 92% among individuals who have advanced AIDS. Anemia which is also one of the major challenges among HIV patients can lead to impaired physical functioning, psychological distress, poor quality of life, accelerated disease progression, and shorter life expectancy. There are different reports that show a large number of patients with both anemia and HIV/AIDS in Ethiopia. However, the burden of anemia among those HIV/AIDS patients receiving ART is not fully understood in Gedeo zone health institutions. Hence, this study is designed to assess the prevalence of anemia and associated factors among adult HIV/AIDS clients receiving ART at Gedeo zone health institutions, SNNPR, Ethiopia. Methods An institution-based cross-sectional study was conducted in Gedeo zone health institutions from November 21 2017 to January 30, 2018. The systematic random sampling technique was used to recruit the study participants. The hematocrit level was used to determine anemic status. Data were entered into EPI info version 7 and transferred to STATA version 12.0 for analysis. In order to identify factors associated with anemia, a multivariable logistic regression analysis was employed. Result A total of 422 patients were included with a mean age of 33.85 (SD = ±9. 12) years. The prevalence of anemia was 34.8% (95% CI 30.1-39.8), while about 7.4%, 14.3%, and 13.1% of the patients had severe, moderate, and mild anemia, respectively. The mean hemoglobin was 14.6 (SD=±10. 8), (95% CI 13.6_15.8). INH/Isoniazid prophylaxis (OR =1.8 [95% CI: 1.1, 2.9]) and bedridden functional status (OR =5.48 [95% CI: 1.25, 23.8]) were determinants of anemia in this study. Conclusion In this study, a large number of pateients had anemia (34.8%) with the majority of them having a moderate form. Functional status and using INH prophylaxis were determinant factors of anemia.
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Affiliation(s)
- Wagaye Alemu Zenebe
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Adane Tesfaye Anbese
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Tinsae Shemelise Tesfaye
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Tamir Z, Seid A, Haileslassie H. Magnitude and associated factors of cytopenias among antiretroviral therapy naïve Human Immunodeficiency Virus infected adults in Dessie, Northeast Ethiopia. PLoS One 2019; 14:e0211708. [PMID: 30759131 PMCID: PMC6373930 DOI: 10.1371/journal.pone.0211708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/18/2019] [Indexed: 12/31/2022] Open
Abstract
Background Hematologic abnormalities involving peripheral blood cell cytopenias are strong predictors of morbidity, mortality and poor antiretroviral therapy (ART) outcomes of HIV infected individuals. However, limited studies are conducted in resource-limited settings of sub-Saharan Africa that have addressed the magnitude and associated factors of cytopenias. This study aimed to investigate the magnitude and associated factors of cytopenias among ART naïve HIV infected adult Ethiopians. Materials and methods A cross-sectional study was conducted among ART naïve HIV infected individuals attending at ART unit of Dessie Referral Hospital between November 01, 2015 and April 30, 2016. A total of 402 adults were included using consecutive sampling. Socio-demographic, clinical and laboratory data of patients were collected. The data were entered to Epi Info version 3.4.3 and analyzed using SPSS version 20 software (SPSS INC, Chicago, IL, USA). Factors associated with cytopenias were analyzed first using bivariate and then multivariate logistic regression models. An odds ratio with 95% confidence interval was used to measure the strength of association. For all statistical significant tests, the cut-off value was set at P<0.05. Results In this study, the overall magnitude of any cytopenia, anemia, leucopenia and thrombocytopenia were 63.4%, 43.5%, 24.4% and 18.7%, respectively. In multivariate logistic regression analysis, severe immunosuppression and WHO clinical stage IV HIV disease were significantly associated with increased prevalence of cytopenias. In addition, older age and younger age showed significant association with increased prevalence of anemia and leucopenia, respectively. Conclusion Frequent occurrence of cytopenias was independently associated with severe immunosuppression and WHO clinical stage IV HIV disease. Further longitudinal multicenter studies are recommended to bolster the findings of this study in order to suggest the need of routine assessment and management of hematological abnormalities for optimal choice of initial antiretroviral agents and prevention of further morbidities.
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Affiliation(s)
- Zemenu Tamir
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Abdurahaman Seid
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Haftay Haileslassie
- Department of Medical Laboratory Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Lv L, Li Y, Fan X, Xie Z, Liang H, Shen T. HCV coinfection aggravated the decrease of platelet counts, but not mean platelet volume in chronic HIV-infected patients. Sci Rep 2018; 8:17497. [PMID: 30504858 PMCID: PMC6269489 DOI: 10.1038/s41598-018-35705-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/09/2018] [Indexed: 01/06/2023] Open
Abstract
Either HIV or HCV monoinfection could result in an abnormal status of platelets. As two key indicators reflecting activation and function of platelets, the changes of platelet counts and mean platelet volume (MPV) in HIV/HCV-coinfected patients have not been clearly identified. In the present study, a total of 318 former plasma donors were investigated in 2006, and 66% (201 individuals) of primary recruiters were followed up in 2014. By horizontal comparison in 2006, the decrease of platelet counts in HIV/HCV coinfection was greater than that in HIV or HCV monoinfection. MPV scores were lower in HIV monoinfection compared with healthy controls, while no difference was found in HIV/HCV coinfection. Platelet counts were shown to be negatively correlated with MPV scores in total recruited population (r = 0.432, P < 0.001). Interestingly, by comparison of data from two time points of 2006 and 2014, significant decrease of platelets (P = 0.004) and increase of MPV (P = 0.004) were found only in HCV monoinfected patients, which may associate with slow progression of hepatic fibrosis induced by chronic HCV infection. Nonetheless, no significant changes of platelet counts and MPV were found from 2006 to 2014 in coinfected patients. In conclusion, HCV coinfection aggravated the decrease of platelet counts, but not MPV score in chronic HIV infection. MPV showed poor applicability in reflecting the status of platelets in HIV/HCV-coinfected patients.
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Affiliation(s)
- Linting Lv
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Yuantao Li
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Xueying Fan
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Zhe Xie
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China
| | - Hua Liang
- State Key laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention, China CDC, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, 102206, China.
| | - Tao Shen
- Department of Microbiology and Center of Infectious Disease, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China.
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18
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Nombela-Arrieta C, Isringhausen S. The Role of the Bone Marrow Stromal Compartment in the Hematopoietic Response to Microbial Infections. Front Immunol 2017; 7:689. [PMID: 28163704 PMCID: PMC5247475 DOI: 10.3389/fimmu.2016.00689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/23/2016] [Indexed: 12/18/2022] Open
Abstract
Continuous production of blood cells unfolds within a complex three-dimensional tissue scaffold established by highly organized stromal cell networks of mesenchymal, neural, and vascular origin inside bone marrow (BM) cavities. Collectively, stromal cells have been shown to serve two principal roles; first as primary participants of bone remodeling and metabolism and second as master regulators of different stages of blood cell development and production. Indeed, ample evidence demonstrates that stromal cells can sense and integrate systemic signals to shape hematopoietic responses and that these regulatory mechanisms are subverted in multiple pathologic conditions. Microbial infections are stressors that elicit potent inflammatory reactions and induce substantial alterations of hematopoietic output. Whether the cellular components of the BM stromal microenvironment are targeted by infections and participate in infection-induced hematopoiesis has not been investigated in sufficient detail to date. In this manuscript, we provide a succinct updated overview of the different cell populations that are currently known to form BM stroma. We discuss experimental evidence demonstrating that different stromal components are actively damaged or functionally altered by pathogens and/or ensuing inflammatory signals and review how these effects are known to contribute to the hematologic manifestations observed during infections.
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Profile of HIV-Infected Hispanics with Pancytopenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010038. [PMID: 26703689 PMCID: PMC4730429 DOI: 10.3390/ijerph13010038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/27/2015] [Accepted: 11/05/2015] [Indexed: 12/18/2022]
Abstract
Pancytopenia is seen in late HIV infection; it is associated with medical complications and with decreased survival. We determined the prevalence of pancytopenia at baseline in a cohort of HIV-positive Hispanics living in Puerto Rico, and compared their socio-demographic, immunological and clinical characteristics. A total of 1202 patients enrolled between 2000 and 2010 were included. They were grouped according to pancytopenia status, defined by having: platelets <150,000 μL, white cell count <4000 μL, and hemoglobin <12 g/dL (women) or <13 g/dL (men). Differences were evaluated using Student's t-test, Chi-square test and Kaplan-Meier method. The prevalence of pancytopenia was 8.7%. Patients with pancytopenia had lower BMI and lower CD4 count, as well as higher HIV viral load and higher proportions of unemployment, clinical AIDS and antiretroviral treatment (ART) use (p < 0.05). One-year mortality rate was significantly higher in patients with pancytopenia (18.1% vs. 5.1%, p < 0.001). When stratifying for ART this association persisted for patients who did not receive ART (41.4% vs. 5.2%, p < 0.001), but it was not seen in patients who received treatment (9.2% vs. 5.6%, p = 0.196). Pancytopenia was associated with elements of advanced stages of HIV. ART could reduce the mortality of HIV-patients with pancytopenia to levels comparable to patients without the disorders.
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van den Berg K, Murphy EL, Pretorius L, Louw VJ. The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: implications for blood services in HIV-endemic countries. Transfus Apher Sci 2014; 51:10-8. [PMID: 25457008 DOI: 10.1016/j.transci.2014.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cytopaenias, especially anaemia, are common in the HIV-infected population. The causes of HIV related cytopaenias are multi-factorial and often overlapping. In addition, many of the drugs used in the management of HIV-positive individuals are myelosuppresive and can both cause and exacerbate anaemia. Even though blood and blood products are still the cornerstone in the management of severe cytopaenias, how HIV may affect blood utilisation is not well understood. The impact of HIV/AIDS on blood collections has been well documented. As the threat posed by HIV on the safety of the blood supply became clearer, South Africa introduced progressively more stringent donor selection criteria, based on the HIV risk profile of the donor cohort from which the blood collected. The implementation of new testing technology in 2008 which significantly improved the safety of the blood supply enabled the removal of what was perceived by many as a racially based donor risk model. However, this new technology had a significant and sustained impact on the cost of blood and blood products in South Africa. In contrast, it would appear little is known of how HIV influences the utilisation of blood and blood products. Considering the high prevalence of HIV among hospitalised patients and the significant risk for anaemia among this group, there would be an expectation that the transfusion requirements of an HIV-infected patient would be higher than that of an HIV-negative patient. However, very little published data is available on this topic which emphasises the need for further large-scale studies to evaluate the impact of HIV/AIDS on the utilisation of blood and blood products and how the large-scale roll-out of ARV programs may in future play a role in determining the country's blood needs.
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Affiliation(s)
- Karin van den Berg
- South African National Blood Service, Port Elizabeth, South Africa; Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Edward L Murphy
- University of California, San Francisco, United States; Blood Systems Research Institute, San Francisco, United States
| | - Lelanie Pretorius
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa; Ampath Laboratories, Bloemfontein, South Africa
| | - Vernon J Louw
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
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Kyeyune R, Saathoff E, Ezeamama AE, Löscher T, Fawzi W, Guwatudde D. Prevalence and correlates of cytopenias in HIV-infected adults initiating highly active antiretroviral therapy in Uganda. BMC Infect Dis 2014; 14:496. [PMID: 25209550 PMCID: PMC4165997 DOI: 10.1186/1471-2334-14-496] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/03/2014] [Indexed: 11/12/2022] Open
Abstract
Background Cytopenias are the most common HIV-associated hematological abnormality. Cytopenias have been associated with several factors including sex, race/ethnicity, geographical location and comorbidities such as tuberculosis, hepatitis B infection, fever and oral candidiasis. Cytopenias become more prevalent as HIV progresses and are often fatal. Data from resource-limited settings about the prevalence and correlates of cytopenia are limited. Therefore we conducted this cross-sectional study to assess the prevalence and correlates of cytopenia among adult AIDS patients at initiation of HAART in Uganda. Methods 400 HIV-infected subjects who were HAART-naïve or on HAART for ≤ 6 months were enrolled into the Multivitamins, HAART and HIV/AIDS Trial. Anemia was defined according to WHO guidelines as any hemoglobin concentration < 12 g/dl for non-pregnant females and < 13 g/dl for males. Leucopenia and thrombocytopenia were defined using study site laboratory reference ranges for lack of generally accepted definitions for these 2 cell lines as leucopenia if white blood cell count < 2.75 × 109 cells/litre and thrombocytopenia if platelets < 125 × 109 cells/litre for females and < 156 × 109 cells/litre for males. Univariate and bivariate analyses were done to describe the patient population and log-binomial regression was used to quantify the correlates of cytopenia. Results Sixty five percent of the 400 subjects had at least one form of cytopenia. Anemia occurred in 47.8%, leucopenia in 24.3%, thrombocytopenia in 8.3%, bicytopenia in 21.9% and only 2 had a pancytopenia. Cytopenia was more prevalent in females (prevalence ratio [PR]:1.33, 95% confidence interval [CI]:1.12-1.59); CD4 count category 50 to <200 (PR: 0.75, 95% CI: 0.64 -0.88) and CD4 count category 200 to <350 (PR: 0.74, 95% CI: 0.59 - 0.92) compared to CD4 count category <50; normal BMI (PR: 0.82, 95% CI:0.68-1.00) and overweight BMI (PR: 0.64, 95% CI:0.50- 0.82) compared to underweight BMI and those with a history or presence of oral candidiasis. Conclusions Cytopenias are a frequent complication in HIV-infected adults at initiation of HAART in Uganda. The presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index. Prospective studies in resource-limited settings on the trend in HIV-related cytopenias are needed.
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Affiliation(s)
- Rachel Kyeyune
- Infectious Diseases Institute, Makerere College of Health Sciences, P,O Box 22418, Kampala, Uganda.
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Autrel-Moignet A, Lamy T. Autoimmune neutropenia. Presse Med 2014; 43:e105-18. [PMID: 24680423 DOI: 10.1016/j.lpm.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 02/08/2023] Open
Abstract
Autoimmune neutropenia (AIN) is a rare entity caused by antibodies directed against neutrophil-specific antigens. It includes primary and secondary autoimmune neutropenia. Acute autoimmune neutropenia can be related to drug-induced mechanism or viral infections. Chronic autoimmune neutropenias occur in the context of autoimmune diseases, hematological malignancies, such as large granular lymphocyte leukemia, primary immune deficiency syndromes or solid tumors. The therapeutic management depends on the etiology. Granulocyte growth factor is the main therapeutic option, raising the question of their long-term utilization safety. Corticosteroids or immunosuppressive therapy are indicated in infection-related AIN or in case of symptomatic autoimmune disease or LGL leukemia.
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Affiliation(s)
| | - Thierry Lamy
- CHU de Rennes, service d'hématologie clinique, Rennes 35043, France; Université Rennes 1, Rennes 35043, France.
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Rivera-Rivera Y, García Y, Toro V, Cappas N, López P, Yamamura Y, Rivera-Amill V. Depression Correlates with Increased Plasma Levels of Inflammatory Cytokines and a Dysregulated Oxidant/Antioxidant Balance in HIV-1-Infected Subjects Undergoing Antiretroviral Therapy. ACTA ACUST UNITED AC 2014; 5. [PMID: 25674354 DOI: 10.4172/2155-9899.1000276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Depression is the most common psychiatric diagnosis in the HIV/AIDS population and represents a risk factor for disease progression. Since HIV-1 infection is characterized by immunologic and metabolic disturbances, we want to study the effects of depression on different components related to pro-inflammatory and oxidative stress markers. We hypothesize that depression will lead to increased pro-inflammatory cytokine levels and altered antioxidant/oxidant balance. METHODS We included males and females who were ≥21 years of age, whose HIV-1 sero-status was confirmed by Western Blot, and who were currently undergoing antiretroviral treatment. Patients completed the participation consent form, a socio-demographic survey, and the Patient Health Questionnaire-9 (PHQ-9) for depression assessment. We isolated the plasma from participants' blood samples for viral load analysis (RT-PCR), T-cell counts (flow cytometry), and hematological parameters. A cytokine magnetic bead panel was used to measure interleukin-15 (IL-15), interferon gamma-induced protein 10 (IP-10), IL-12 and granulocyte colony-stimulating factor (G-CSF) levels. We also performed assays to determine the antioxidant activity of superoxide dismutase (SOD) and catalase and to measure the lipid peroxidation levels using malondialdehyde (MDA) and 8-isoprostane assays. Statistical comparisons and correlations at 5% level of significance were determined. RESULTS Our results show that subjects with mild/moderate to severe depression as assessed by PHQ-9 had a significantly decreased adherence to anti-retroviral treatment. Subjects with depression also had significantly lower levels of white blood cells (WBC) and platelets (PLT) than did the non-depressed group. The HIV+ subjects with depression had increased levels of IL-15, IP-10, IL-12 p40/p70 and G-CSF compared to their non-depressed counterparts. The latter had increased MDA and 8-isoprostane levels. CONCLUSIONS Our results suggest that HIV+ subjects with depressive symptoms have higher levels of inflammation and altered oxidant/antioxidant balance. Although the groups were small, this study strengthens the hypothesis that alterations in cytokines are associated with the mechanisms underlying depression symptoms.
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Affiliation(s)
- Yainyrette Rivera-Rivera
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Yashira García
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Valerie Toro
- Department of Clinical Psychology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Nydia Cappas
- Department of Clinical Psychology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Pablo López
- AIDS Research Program, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Yasuhiro Yamamura
- AIDS Research Program, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
| | - Vanessa Rivera-Amill
- Department of Microbiology, Ponce Health Sciences University-School of Medicine/ Ponce Research Institute, USA
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Brunetta DM, De Santis GC, Vilar FC, Brandão RA, Muniz RZDA, Lima GMND, Amorelli-Chacel ME, Covas DT, Machado AA. Hematological particularities and co-infections in injected drug users with AIDS. Braz J Infect Dis 2013; 17:654-6. [PMID: 24001391 PMCID: PMC9427417 DOI: 10.1016/j.bjid.2013.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 02/07/2013] [Accepted: 03/23/2013] [Indexed: 11/22/2022] Open
Abstract
HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL−1 and lymphocyte <1000 μL−1 had CD4 count lower than 100 μL−1. In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.
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Affiliation(s)
- Denise Menezes Brunetta
- Center for Cell Based Therapy, Medical School of Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
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Gedefaw L, Yemane T, Sahlemariam Z, Yilma D. Anemia and risk factors in HAART naïve and HAART experienced HIV positive persons in south west Ethiopia: a comparative study. PLoS One 2013; 8:e72202. [PMID: 23977253 PMCID: PMC3745448 DOI: 10.1371/journal.pone.0072202] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/08/2013] [Indexed: 12/02/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection and its treatment cause a range of hematological abnormalities. Anemia is one of the commonly observed hematologic manifestations in HIV positive persons and it has multifactorial origin. Objective We aimed to determine the prevalence and risk factors of anemia in highly active antiretroviral therapy (HAART) naïve and HAART experienced HIV positive persons. Methods A facility-based comparative cross sectional study was conducted in Jimma University Specialized Hospital from February 1 to March 30, 2012. A total of 234 HIV positive persons, 117 HAART naïve and 117 HAART experienced, were enrolled in this study. Blood and stool specimens were collected from each participant. Blood specimens were examined for complete blood count, CD4 count and blood film for malaria hemoparasite; whereas stool specimens were checked for ova of intestinal parasites. Socio-demographic characteristics and clinical data of the participants were collected using pre-tested questionnaire. Statistical analysis of the data (Chi-square, student’s t-test, logistic regression) was done using SPSS V-16. Results The overall prevalence of anemia was 23.1%. The prevalence of anemia in HAART naïve and HAART experienced persons was 29.9% and 16.2%, respectively (P = 0.014). Presence of opportunistic infections (P = 0.004, 95% CI = 1.69–15.46), CD4 count <200 cells/µl (P = 0.001, 95% CI = 2.57–36.89) and rural residence (P = 0.03, 95% CI = 1.12–10.39) were found to be predictors of anemia for HAART naïve participants. On the other hand, HAART regimen (ZDV/3TC/NVP) (P = 0.019, 95% CI = 0.01–1.24) and the duration of HAART (P = 0.007, 95% CI = 0.003–0.40.24) were found to be predictors of anemia for HAART experienced groups. Conclusion The prevalence of anemia in HAART naïve persons was higher than HAART experienced persons. Risk factors for anemia in HAART naïve and HAART experienced HIV positive persons were different. Hence, there is a need for longitudinal study to further explore the causes of HIV associated anemia and the pattern of hemoglobin changes with initiation of HAART.
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Affiliation(s)
- Lealem Gedefaw
- Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Ethiopia.
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Ferede G, Wondimeneh Y. Prevalence and related factors of anemia in HAART-naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia. BMC BLOOD DISORDERS 2013; 13:8. [PMID: 24238076 PMCID: PMC4176740 DOI: 10.1186/2052-1839-13-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 08/07/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anaemia is a common complication of infection with the human immunodeficiency virus (HIV) and may have various causes. The aim of this study was to determine the prevalence and related factors of anemia in HAART-naive HIV positive Patients. METHODS A retrospective study was conducted on HAART naive HIV positive patients at the Gondar University Hospital between September 2011 and August 2012. Socio-demographic and immunohematological (hemoglobin and CD4+ T cells) data were collected carefully from the existing ART logbook and patient follow up cards. Anaemia was defined according to the WHO criteria. RESULTS The overall prevalence of anaemia was 138 (35%). Female HAART naive HIV positive patients had significantly (P < 0.05) higher prevalence of anaemia than males (62% Vs 38%). The prevalence of anaemia at different CD4 level was; 6 (4%) with CD4 count greater than 500 cells/μL, 18 (13%) with a CD4 count of 350-500 cells/μL, 37 (27%) with a CD4 count of 200-349 cells/μL, 44 (32%) with a CD4 count of 100-199 cells/μL, 14 (10%) with a CD4 count of 50-99 and 19 (14%) with CD4 count of less than 50 cells/μL. CONCLUSIONS Our findings showed that one-third of HAART naïve HIV positive patients were anaemic and the increase in prevalence of anaemia with decreased CD4 cell count was statistically significant. Therefore, early diagnosis and treatment of anaemia in these patients are essential.
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Affiliation(s)
- Getachew Ferede
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P,O, Box 196, Gondar, Ethiopia.
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van den Berg K, van Hasselt J, Bloch E, Crookes R, Kelley J, Berger J, Ingram C, Dippenaar A, Thejpal R, Littleton N, Elliz T, Reubenson G, Cotton M, Hull JC, Moodley P, Goga Y, Eldridge W, Patel M, Hefer E, Bird A. A review of the use of blood and blood products in HIV-infected patients. South Afr J HIV Med 2012; 13:87-104. [PMID: 28479876 PMCID: PMC5419681 DOI: 10.4102/sajhivmed.v13i2.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed.
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Topics on HIV/AIDS for Inclusion Into a Physical Therapy Curriculum: Consensus Through a Modified Delphi Technique. ACTA ACUST UNITED AC 2012. [DOI: 10.1097/00001416-201201000-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Santis GC, Brunetta DM, Vilar FC, Brandão RA, de Albernaz Muniz RZ, de Lima GMN, Amorelli-Chacel ME, Covas DT, Machado AA. Hematological abnormalities in HIV-infected patients. Int J Infect Dis 2011; 15:e808-11. [DOI: 10.1016/j.ijid.2011.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 07/12/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022] Open
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Severe myelosuppression and MRSA infection as the presentation of perinatal HIV infection. Pediatr Infect Dis J 2011; 30:727-8. [PMID: 21750452 DOI: 10.1097/inf.0b013e31821e8b36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mata-Marín JA, Gaytán-Martínez JE, Martínez-Martínez RE, Arroyo-Anduiza CI, Fuentes-Allen JL, Casarrubias-Ramirez M. Risk factors and correlates for anemia in HIV treatment-naïve infected patients: a cross-sectional analytical study. BMC Res Notes 2010; 3:230. [PMID: 20727136 PMCID: PMC2941498 DOI: 10.1186/1756-0500-3-230] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 08/20/2010] [Indexed: 11/17/2022] Open
Abstract
Background Hematologic manifestations of the human immunodeficiency virus (HIV) infection are a well-recognized complication of the disease and may be clinically important. Our objective was to determine the risk factors for anemia and its correlation with HIV treatment-naïve infected patients without co-infection or opportunistic diseases. Findings We performed a cross-sectional comparative study in which HIV treatment-naïve infected patients with anemia were compared with a control group of HIV patients without anemia. The interrelationship between risk factors and anemia was determined. Odds ratio and 95% confidence intervals were calculated, to adjust for the effects of potential confounders and we used a logistic regression model. Pearson's correlation coefficient was obtained to calculate the correlation between risk factors and hemoglobin. We enrolled 54 men and 9 women. Anemia was found in 13 patients; prevalence .20 (CI 95% 0.12-0.32). Severe anemia was found in only one patient (1.5%). Only CD4+ Cells Count <200 cells/mm3 was associated with increased risk of anemia in the multivariate analysis. There was a moderately strong, positive correlation between WBC and hemoglobin (r = 0.49, P < 0.001) and between CD4+ cell count and hemoglobin (r = 0.595, P < 0.001) and a moderately strong, negative correlation between HIV RNA viral load and hemoglobin (r = - 0.433, P < 0.001). Conclusions Anemia is a common manifestation in the Mexican population without antiretroviral therapy. In HIV naïve patients a CD4+ Cell Count < 200 cells/mm3 was associated with an increased risk of anemia. There is a positive correlation between hemoglobin and CD4+ cell count.
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Affiliation(s)
- José A Mata-Marín
- Infectious Diseases Department, Hospital de Infectología, "La Raza" National Medical Center, IMSS, Mexico City, México.
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Van As M, Myezwa H, Stewart A, Maleka D, Musenge E. The International Classification of Function Disability and Health (ICF) in adults visiting the HIV outpatient clinic at a regional hospital in Johannesburg, South Africa. AIDS Care 2008; 21:50-8. [DOI: 10.1080/09540120802068829] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Melissa Van As
- a Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
| | - Hellen Myezwa
- a Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
| | - Aimee Stewart
- a Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
| | - Douglas Maleka
- a Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
| | - Eustasius Musenge
- a Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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Hasserjian RP. Reactive versus neoplastic bone marrow: problems and pitfalls. Arch Pathol Lab Med 2008; 132:587-94. [PMID: 18384210 DOI: 10.5858/2008-132-587-rvnbmp] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2007] [Indexed: 11/06/2022]
Abstract
Examination of the bone marrow poses several unique challenges to the pathologist: it is a semisolid organ without helpful gross correlation, it exists in a dynamic state with the peripheral blood and other organs of the lymphohemopoietic system, and the diagnosis of diseases affecting bone marrow often depends heavily on ancillary special studies. The bone marrow examination ideally encompasses review of the bone marrow biopsy histology (with or without additional nondecalcified clot preparation material), bone marrow aspirate smear cytology, and the peripheral blood smear; optimal procurement and processing of these samples is critical in ensuring that a maximal level of diagnostic information can be extracted. The pathologist must be aware of the clinical context of the bone marrow and the results of ancillary tests, whether these are ordered by the pathologist or the clinician. A combination of excellent diagnostic samples, appropriate ancillary tests, and knowledge of the clinical context provides the best background to distinguish between the common reactive and neoplastic processes that involve the bone marrow and to avoid diagnostic pitfalls in making these distinctions.
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Affiliation(s)
- Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02115, USA.
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Rieg G, Yeaman M, Lail AE, Donfield SM, Gomperts ED, Daar ES. Platelet count is associated with plasma HIV type 1 RNA and disease progression. AIDS Res Hum Retroviruses 2007; 23:1257-61. [PMID: 17961113 DOI: 10.1089/aid.2006.0311] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thrombocytopenia is a common finding among HIV-1-infected individuals. In addition to their function in hemostasis, platelets have been found to play a role in host immune defenses and to directly interact with HIV-1. To explore the role of platelets in HIV-1 infection, we examined the relationship between platelet number and the natural history of HIV-1 disease in the well-characterized Hemophilia Growth and Development Study cohort. In a multivariate analysis platelets were found to be inversely related to plasma HIV-1 RNA with increasing platelets associated with lower plasma HIV-1 RNA levels (p < 0.001). Despite this, increasing platelet count was independently associated with enhanced risk of progression to AIDS and death (p < 0.001 for both). While there may be multiple explanations for these novel observations, they do generate hypotheses related to the potential influence platelets may have on the natural history of HIV-1 disease.
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Affiliation(s)
- Gunter Rieg
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California 90095
- Divisions of HIV Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Michael Yeaman
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California 90095
- Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | | | | | | | - Eric S. Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California 90095
- Divisions of HIV Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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Ngo AT, Duc NH, Lan NH, Maynart M, Mayaud C, Quy TH. [Mechanisms and causes of death in 143 Vietnamese HIV-infected patients hospitalized for tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:139-46. [PMID: 17675937 DOI: 10.1016/s0761-8417(07)90118-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE OF THE STUDY To know the mechanisms and causes of death in Vietnamese VIH-infected patients hospitalized for tuberculosis. METHODS Retrospective analysis of a monocentric cohort of 143 consecutive co infected patients admitted to Pham Ngoc Thach Hospital, in Ho Chi Minh City, between January 2004 and November 2004. MAIN RESULTS All the patients were HIV-infected and AFB smear positive. The CD4 T lymphocyte count was 55/mm3 and the body mass index was 15.8 +/- 2 kg/m2. During the first three months after hospital admission and tuberculosis diagnosis, the percentage of deaths was 28.7% (41/143). The mechanisms of deaths were: progressive cachexia, acute respiratory failure, cardiogenic or bacteremic shock, coma and unexpected cardio respiratory arrest. The causes of death were tuberculosis (particularly mechanical complications such as compressive pneumothorax, pericarditis or pleuritis), metabolic disorders (mainly hyponatrémie and dyskaliema) and associated infection. In multivariate analysis, two parameters (available at admission) were predictive of short-term death: anemia (p=0.024) and hyponatrémie (p=0.026). CONCLUSION The short term mortality of co infected patients with AIDS and tuberculosis remains high in developing countries. However, some causes of death such as compressive pneumothorax-pleuritis-pericarditis, metabolic disorder or even associated opportunistic infection i. e. pneumocystosis may be prevented or cured. Consequently, such patients must be carefully monitored and more particularly those with severe anemia and/or hyponatrémie at admission. Similarly appropriate diagnostic algorithms must be used in case of unfavorable evolution particularly to diagnose curable complication.
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Affiliation(s)
- A T Ngo
- Pham Ngoc Thach Hospital, 120 Hung Vuong St, District 5, Ho Chi Minh City, Vietnam
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Heit B, Jones G, Knight D, Antony JM, Gill MJ, Brown C, Power C, Kubes P. HIV and other lentiviral infections cause defects in neutrophil chemotaxis, recruitment, and cell structure: immunorestorative effects of granulocyte-macrophage colony-stimulating factor. THE JOURNAL OF IMMUNOLOGY 2006; 177:6405-14. [PMID: 17056572 DOI: 10.4049/jimmunol.177.9.6405] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with HIV infection exhibit deficits in bacterial and fungal clearance, and possibly depressed innate immunity. In this study, we observed that neutrophils from HIV-infected patients have a profound defect in chemotaxis in response to endogenous (IL-8) and bacterial (fMLP) chemoattractants, which was directly correlated with peripheral CD4(+) lymphocyte levels but not plasma viral load. A similar chemotactic defect was observed in the feline immunodeficiency virus (FIV) model of HIV infection. Intravital microscopy of FIV-infected animals revealed marked impairment in the in vivo recruitment of leukocytes; specifically integrin-dependent neutrophil adhesion and emigration induced by bacterial products. Treatment of FIV-infected animals with GM-CSF re-established both neutrophil recruitment (rolling, adhesion, and emigration) and in vitro chemotaxis to the levels seen in uninfected animals. This restoration of neutrophil responses was not due to GM-CSF-mediated priming. Rather, HIV and FIV infections resulted in defective neutrophil development, with an ensuing reduction in neutrophil granularity and chemotactic receptor expression. GM-CSF therapy restored neutrophil granularity, implying restoration of normal neutrophil development. Together, our findings underscore the fundamental defects in innate immunity caused by lentivirus infections, while also indicating that GM-CSF may be a potential immunorestorative therapy for HIV-infected patients.
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Affiliation(s)
- Bryan Heit
- Immunology Research Group, Department of Physiology and Biophysics, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta, Canada T2N 4N1
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Miguez MJ, Rodríguez A, Hadrigan S, Asthana D, Burbano X, Fletcher MA. Interleukin-6 and platelet protagonists in T lymphocyte and virological response. Platelets 2005; 16:281-6. [PMID: 16011978 DOI: 10.1080/09537100400028727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present cross-sectional study evaluated the status and relationship of interleukin-6, a platelet growth factor, with platelet counts, viral load, CD4 counts, and antiretroviral treatment in 75 HIV-infected subjects with thrombocytopenia and 50 gender-, race-, age- and antiretroviral treatment-matched controls without thrombocytopenia. Mean IL-6 production was significantly higher in thrombocytopenic participants (13 432+/-8596) than in non-thrombocytopenic subjects (12 859+/-3538 pg/10(5) Lym). Univariate analyses indicated, however, that thrombocytopenic patients were more likely to have <3000 pg of IL-6 than non-thrombocytopenic patients (OR=7 95% CI 1.3-12; P=0.01). For additional analyses, participants were dichotomized above and below 3000 pg of IL-6. Despite similar age, gender, drug use and antiretroviral treatment, thrombocytopenic participants had lower CD4 counts (186.5+/-149 vs. 401+/-286, P=0.005) than non-thrombocytopenic subjects. Thrombocytopenic participants with elevated IL-6, with or without HAART, were more likely to have higher HIV-replication (496 273+/-210 416; 34 656+/-25 332) than thrombocytopenic individuals with low IL-6 levels (105 332+/-42 699; 19 015+/-14 296 P=0.05). Non-thrombocytopenic patients with high IL-6 levels exhibited the highest CD4s (466.7+/-333) and the lowest viral burden (63 094+/-53 300) of the groups. Two distinct categories of HIV-associated thrombocytopenia exist: one accompanied by low IL-6, and another with compensatory elevations of IL-6. In thrombocytopenic individuals, the latter was associated with the poorest immunological and virological responses.
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Affiliation(s)
- Maria Jose Miguez
- Department of Psychiatry, Division of Disease Prevention, University of Miami, School of Medicine, Miami, FL 33136, USA.
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Abstract
Bone marrow morphology is frequently abnormal in patients with AIDS. In this study, we reviewed 97 bone marrow biopsies of AIDS patients performed between 1998 and 2000 in the Emílio Ribas Institute of Infectology, which is the reference department for HIV. Specific diagnoses were performed in 33 cases. Fungi were observed in eight cases. Five of them were Histoplasma capsulatum, two were Cryptococcus neoformans, and one probably Candida albicans. Acid-fast bacilli were observed in 12 bone marrow biopsies, three of which were diagnosed to have no mycobacteriosis clinically. Foci of necrosis with clusters of macrophages without any well-formed granuloma were observed in nine cases and well-formed granuloma in three cases. Lymphomatous infiltration was observed in four cases of non-Hodgkin's lymphoma and in two Hodgkin's diseases (mixed cellularity). Extensive necrosis of bone marrow was observed in one case of Burkitt's lymphoma. In conclusion, bone marrow biopsy should be performed to elucidate the etiology of cytopenias, secondary infections, and fever of undetermined origin in AIDS patients.
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Affiliation(s)
- Edenilson Eduardo Calore
- Emílio Ribas Institute of Infectology, Pathology Section, Av. Dr. Arnaldo 165, São Paulo 01246-902, Brazil.
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Robertson P, Scadden DT. Immune reconstitution in HIV infection and its relationship to cancer. Hematol Oncol Clin North Am 2003; 17:703-16, vi. [PMID: 12852652 DOI: 10.1016/s0889-8588(03)00047-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
HIV infection results in formidable immune dysfunction, widely affecting the immune system, but typified by T lymphopenia. This dysfunction includes a perturbed immune response to several persistent viruses that have a propensity to cause tumors. Effective control of HIV replication by highly active antiretroviral therapy (HAART) results in regeneration of the damaged immune system, and recent advances have allowed this immune reconstitution to be better defined. This article describes the immunodeficiency caused by HIV and the response of the immune system to HAART, with specific reference to the immune response to cancers associated with HIV infection.
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Affiliation(s)
- Paul Robertson
- AIDS Research Center, Massachusetts General Hospital, Harvard Medical School 149, 13th Street, Room 5212, Boston, MA 02109, USA
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Miguez MJ, Burbano X, Archer H, Shor-Posner G. Limited impact of highly active antiretroviral therapy in thrombocytopenia. J Acquir Immune Defic Syndr 2002; 30:260-1. [PMID: 12045691 DOI: 10.1097/00042560-200206010-00017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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