Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

Magnitude and Factors Associated with Cytopenia Among Children on Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Science, Sidama Region, Southern Ethiopia

Background

The most common abnormality in HIV-infected children is cytopenia, a hematological complication characterized by a decline in any of the blood cell lines. It is associated with a higher risk of morbidity and mortality. Therefore, this study aimed to assess the prevalence and associated factors of cytopenia among HIV-positive children on highly active antiretroviral therapy (HAART).

Methods

Hospital-based cross-sectional study design was conducted on HIV-positive children on HAART from July to September 2020. Socio-demographic and clinical characteristics of the study participants' data were collected using a structured questionnaire. Hematological parameters from the blood sample were analyzed using Ruby Cell-Dyne 300 hematology auto-analyzer. The data were analyzed using SPSS version 20. Logistic regression was used to assess the predictors of cytopenia among the study participants. P-values of less than 0.05 are considered statistically significant.

Results

Two hundred seventy-three HAART-experienced children were enrolled in this study, and 50.9% were females. At baseline, 40.7% of children were anemic. The overall magnitude of cytopenia among the study participants was 26.7%. The prevalence of anemia, thrombocytopenia, leucopenia and neutropenia among children was 11.4%, 4.0%, 14.3%, and 18.3%, respectively. Patients with an undetectable viral load (AOR = 0.5, CI = 0.3-0.9) are 50% less likely to report cytopenia. HAART-experienced children living in rural areas are more likely to develop cytopenia (AOR = 2.6, CI = 1.3-5.2) than those living in urban areas.

Conclusion

Hematologic abnormalities are common problems among children on highly active antiretroviral therapy. Therefore, routine investigation of hematological and immunological changes following appropriate therapeutic interventions is recommended.

Evaluation of Hematological, Biochemical Profiles and Molecular Detection of Envelope Gene (gp-41) in Human Immunodeficiency Virus (HIV) among Newly Diagnosed Patients

The Human Immunodeficiency Virus (HIV) is a highly morphic, retrovirus that rapidly evolves through mutation as well as recombination. Because of the immunocompromised status in HIV patients, there is often a higher chance of acquiring different secondary infections followed by liver cirrhosis, hepatitis B & C, and HIV-associated nephropathy. The current study was conducted to see the prevalence of secondary infections, hematological and biochemical markers for liver and renal associated diseases, and to detect the envelope gene (GP41) in newly diagnosed HIV patients. A total of 37 samples were collected from HIV-positive patients registered in different hospital settings under the National AIDS control program. The collected samples were processed for hepatitis B, hepatitis C, hematological analysis, and biochemical analysis. To identify the envelope gene in newly diagnosed HIV patients, polymerase chain reaction (PCR) was performed using four gene-specific primers. The HIV infections were seen more in male as compared to females. A significant decrease in complete blood count was observed in HIV patients when compared to healthy individuals. There was a significant increase in aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine observed in HIV patients. No significant difference was observed in alkaline phosphatase (ALP), total bilirubin, and albumin levels when compared to healthy control. Anemia was observed in 59.4% of HIV patients. A total of three (8.1%) patients were found to be co-infected with hepatitis B and one (2.7 %) was co-infected with hepatitis C. Out of these 37 tested samples, a total of four showed the successful amplification of the envelope gene. This study provides platform for the health care facilitators to regularly monitor the signs, symptoms and clinical biomarkers of HIV-associated infections to prevent toxicity at an early stage to improve the quality of life (QoL) and minimize the mortality rate in HIV patients. Envelope gene mutating frequently results in drug resistance, and thus future research on polymorphism analysis will reveal points of substitutions to improve drug designing.

Prevalence of anemia among people living with HIV: A systematic review and meta-analysis

BACKGROUND

Anemia is the most frequent hematologic abnormality among people living with human immunodeficiency virus (HIV) (PLWHIV) and is associated with HIV disease progression and higher risk of mortality of the patients. However, there is a wide variation of the prevalence of anemia among PLWHIV in different clinical settings. We aimed to obtain more precise estimates of prevalence of anemia and severity of anemia among PLWHIV, which may be important for patients, caregivers, researchers and health policy-makers.

METHODS

We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for original articles reporting the prevalence of anemia defined using age and sex-specific hemoglobin levels according to World Health Organization criteria among PLWHIV from inception to August 31, 2021. We used DerSimonian-Laird random-effects meta-analyses to obtain pooled prevalence and 95% confidence intervals (CIs) of anemia and severity of anemia among PLWHIV. A univariable meta-regression has been conducted to assess the association between anemia prevalence and study characteristics, including study design, median year of sampling, geographical region, World Bank Income level, and proportion of antiretroviral therapy (ART).

FINDINGS

We included 63 observational studies covering 110,113 PLWHIV. The pooled prevalence of anemia was 39.7% (95% CI: 31.4%-48.0%) for children living with HIV aged <15 years, 46.6% (95% CI: 41.9%-51.4%) for adults (men and non-pregnant women) living with HIV aged ≥15 years, and 48.6% (95% CI: 41.6%-55.6%) for pregnant women living with HIV. Among adults living with HIV, the pooled prevalence of severity of anemia was 21.6% (95% CI: 19.9%-23.3%), 22.6% (95% CI: 14.8%-30.4%), and 6.2% (95% CI: 4.4%-8.1%) for mild, moderate and severe anemia, respectively. Compared with East Africa, anemia prevalence among adults living with HIV was higher in Southern Africa (p = 0.033).

INTERPRETATION

Anemia is prevalent among PLWHIV. Thus, policies, strategies, and programs should be considered to identify the predictors of anemia among PLWHIV to reduce the burden of anemia among patients in the ART era.

Virological failure and associated factors among children receiving anti-retroviral therapy, Northwest Ethiopia

BACKGROUND

Virological failure is under-recognized issue among children living with human immunodeficiency virus in developing countries. This partly may lead to failure to achieve the global goal of 90-90-90 targets in most developing countries including Ethiopia.

OBJECTIVES

This study aimed to assess the virological failure and its predictors among children receiving antiretroviral therapy at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

METHODS

An institutional based cross-sectional study was conducted among 253 study cohorts from January 2020-April 2021. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview, while detailed clinical data of the children were collected by reviewing the medical record. About 5 ml of blood were collected for the analysis of complete blood count and viral load quantification. Data were analyzed using SPSS version 20 and variables at p-value < 0.05 in the multivariable analysis were considered as statistically significant.

RESULTS

In this study, the viral load suppression rate among antiretroviral therapy experienced children was 68.8%. Meanwhile, the overall virological failure among study participants was 19.4%. Children living without family (AOR = 3.63; 95%CI: 1.27-10.24), children with unemployed family (AOR = 4.95; 95%CI: 1.74-14.12), being wasted (AOR = 3.02; 95%CI: 1.19-7.67) being stunted (AOR = 2.38;95%CI:1.03-5.46), anemia (AOR = 5.50:95%CI;1.37-22.04) and being lymphopenic (AOR = 2.69:95%CI;1.04-7.75) were significantly associated with virological failure among children under treatment.

CONCLUSION

Higher virological failure among children was noteworthy in the present study. Caretakers other than immediate family, unemployed family, wasted, stunted, anemia, and lymphopenia were significant independent predictors of virological failure. Hence, standard, and optimal management of children under treatment should be warranted.