Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A cross-sectional study

Abstract

Background: HIV/AIDS causes high morbidity and mortality through both immunosuppression and complications not directly related to immunosuppression. Haematological abnormalities, including various cytopenias, occur commonly in HIV through immune and non-immune pathways. Though these complications could potentially cause serious clinical implications, published literature on the magnitude of this problem and its associated factors in Tanzania is scarce. This study aimed at determining the prevalence and risk factors of HIV-associated cytopenias among ART-naive patients enrolling for care and treatment services at Bugando Care and Treatment Centre (CTC) in Mwanza, Tanzania.

Methods: This was a cross-sectional clinic-based study done between March 2015 and February 2016, involving all antiretroviral therapy (ART)-naive adult HIV-positive patients enrolling for care and treatment services at Bugando CTC. Patients younger than 18 years and those with missing data were excluded. Data were analysed using Stata version 11 to determine the prevalence and risk factors of cytopenias.

Results: A total of 1205 ART-naive patients were included. Median age was 41 years (interquartile range [IQR] 32 to 48). Most participants were female (n = 789; 65.6%), with a female-to-male ratio of 2:1. The median baseline CD4 count was 200 cells/µL (IQR 113 to 439). About half (49%) of the study participants had baseline CD4 counts less than 200 cells/µL. Anaemia, leucopenia, and thrombocytopenia were found in 704 (58.4%), 285 (23.6%), and 174 (14.4%) participants, respectively, and these were strongly associated with advanced HIV infection.

Conclusions: The magnitude of cytopenias is high among ART-naive HIV-positive adults, and cytopenias are more marked with advanced HIV infection. Early diagnosis of HIV and timely initiation of ART could potentially reduce the number of people living with advanced HIV disease and its associated complications, including the cytopenias investigated in this study. Patients with cytopenias should undergo thorough screening for tuberculosis, which is an important and treatable correlate of cytopenia, in addition to close follow-up for any potential negative outcomes.

Figure 1

Opportunistic illness diagnoses among 1205 ART-naive HIV-positive adults PPE = pruritic papular eruption; PTB = pulmonary tuberculosis; HZ = herpes zoster; PGL = persistent generalised lymphadenopathy; EPTB = extrapulmonary tuberculosis; ORCA = oral candidiasis; BPNA = recurrent bacterial pneumonia; CDIA = chronic diarrhoea; OESCA = oesophageal candidiasis; PCP = Pneumocystis jirovecii pneumonia

Figure 2

Distribution of 1205 ART-naive HIV-positive adults

Figure 3

Cytopenia type by CD4 count among 1205 ART-naive HIV-positive patients