Neutropenia in HIV-Infected Kenyan Women Receiving Triple Antiretroviral Prophylaxis to Prevent Mother-to-Child HIV Transmission Is Not Associated with Serious Clinical Sequelae

Abstract

Background: Absolute neutrophil counts (ANCs) are lower in East African adults. To assess the impact of lower ANCs, we reviewed data from HIV-infected Kenyan women receiving antiretroviral therapy antepartum and postpartum.

Methods: The Kisumu Breastfeeding Study (KiBS) participants received an antiretroviral regimen from 34 weeks' gestation through 6 months postpartum. Measured ANCs and subsequent illnesses were reviewed. Adverse events (AEs) potentially attributable to neutropenia were identified, and ANCs were graded using the 2004 Division of AIDS table for Grading the Severity of AEs.

Results: Among 478 women with ≥1 postpartum ANC measured, 298 (62.1%) women met criteria for an AE (<1.3 × 10(9) cells/L). Of those, 38 (12.5%) women experienced a nonlife-threatening illness potentially attributable to neutropenia.

Conclusion: More than half of KiBS women met criteria for neutropenia. The mild clinical experience of most participants with low ANCs supports that these values might be typical for this population and may not result in adverse clinical sequelae.

Keywords: African; HIV infected; absolute neutrophil counts; adverse events; pregnant.

Figure 1

Number of mothers enrolled in Kisumu Breastfeeding Study according to neutropenia status during study and the frequencies of illness potentially associated with neutropenia. *For this analysis we considered the following infections occurring at the same time as a neutropenia event as potentially causative of neutropenia: cholera, diarrhea, dysentery, esophageal candidiasis, salmonellosis, typhoid, enteric fever, schistosomiasis, persistent diarrhea, loose stools, aspiration pneumonitis, bronchiolitis, bronchitis, pneumonia, pneumocystis pneumonia, tuberculosis, sepsis, neonatal sepsis, boils/abscess, cellulitis, mumps, tonsillitis, pelvic inflammatory disease, urinary tract infection, genital abscess, cervicitis, infected episiotomy, puerperal sepsis, cerebral malaria, meningitis, pyomyositis, infected laparotomy scar, sexually transmitted diseases, rabies, malaria, measles, and fever septic shock, chills. **Illnesses potentially related to a neutropenia event included pneumonia, fever, gastroenteritis, boils, abscess, malaria, cellulitis, sepsis, sudden death, septicemia, or herpes zoster.