Study of haematological abnormalities in HIV infected patients and its correlation with CD4 counts
Keywords:AIDS, CD4 counts, Cytopenias, Clinical, Correlation, Haematological, HIV
Background: To study and correlate the haematological abnormalities with CD4 cell counts in HIV infected patients diagnosed on OPD basis in S.C.B Medical College, Cuttack, before they are initiated on Antiretroviral (ARV) therapy.
Methods: A 100, ELISA positive, untreated HIV patients were included in the study while those patients with history of any haematological disease, Chronic Kidney Disease (CKD), Chronic Liver Disease (CLD), underlying malignancy or on chemotherapy were excluded. Following clinical evaluation, haemoglobin levels (Hb. %), Total Leucocyte Count (TLC), Differential Leucocyte Count (DLC), Erythrocyte Sedimentation Rate (ESR), Platelet Count (PC), CD4 counts (by flow cytometry) and peripheral smear examination was done. They were staged as per WHO clinical staging guidelines given by NACO and statistical analysis was drawn by Fischer Exact Test and association between CD4 counts and haematological abnormalities were inferred.
Results: The mean age of the patients was found to be 36.85±6.2 years with males (63%), married (80%) and rural population (78%) showing commonest mode of transmission of the virus as heterosexual route (94%). Most common clinical finding was found to be pallor (68%) with majority in stage III of AIDS. Mean TLC count was found to be 5872±2210 cells/mm 2.40% had leucopenia on TLC and 29% had neutropenia, 30% lymphocytopenia and 20% monocytopenia on DLC. Mean CD4 count was 89 cells per microliter and 79% were anaemic. CD4 counts did not statistically correlate either with WHO staging or cytopenias or haemoglobin levels. However, there was positive association between CD4 counts with anaemia, WHO stages of AIDS, lymphocytopenia and monocytopenia in this study.
Conclusions: In this study we could ascertain that, majority were in WHO stage III of AIDS with CD4 counts <200 cells per microliter and blood findings of various cytopenias and anaemia. From our findings, we could correlate between WHO stage of AIDS, CD4 counts and haematological abnormalities thus, establishing the essence of our study.
CDC. Unexplained immunodeficiency and opportunistic infection in HIV. New York, New Jersey, California, MMWR. 1982;31;665-7.
Centre for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR. 1992;41;1-19.
Ghosh TK. Aids: A serious challenge to public health. J Indian Med Association. 1986 Jan;84(1):29-30.
Panda S, Chatterjee A. Abdul-Quader AS. The epidemic and the response in India an Overview. 2002:20.
Annual Report. Odisha State AIDS Control Society (OSACS), Department of Health and Family Welfare, Govt. Of Odisha; 2009. Available at: www.osacs.nic.in
Evolution of HIV-1 in India, Pradeep Seth. Ind J Virolo. June 2010. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3550774/
Mann J, Chin J, Piot P. The international epidemiology of AIDS. Sci Am. 1988;259:82-9.
European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples BMJ. 1992;304:809-13.
Zon LI, Arkin C, Groopman JE, Hematologic Manifestations of the HIV, Semin Hematol. 1988;25:208.
Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Adult/Adolescent Spectrum of Disease Group. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood. 1998 Jan 1;91(1):301-8.
WHO Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity, Vitamin and Mineral Nutrition Information System (VMNIS), WHO. Available at: www.who.int/vmnis/anemia/database/countries/ind_ida.pdf?ua=1.
Moore RD, Keruly JC, Chaisson RE. Neutropenia and bacterial infection in acquired immunodeficiency syndrome. Archives of internal medicine. 1995 Oct 9;155(18):1965-70.
Pechere M, Samii K, Hirschel B. HIV related thrombocytopenia, N Engl J Med. 1993;328:1785.
Sullivan PS, Hanson DL, Chu SY, Jones JL, Ciesielski CA. Adult/Adolescent Spectrum of Disease Group. Surveillance for thrombocytopenia in persons infected with HIV: results from the multistate Adult and Adolescent Spectrum of Disease Project. JAIDS J Acq Immu Defici Syndr. 1997 Apr 1;14(4):374-9.
National AIDS Control Organization (NACO), Annual Report 2009-10. Available at: www.naco.gov.in/sites/default/files/NACO_AR_English%202009_10_NEW.pdf.
Ghiya R, Naik E, Casanas B, Izurieta R, Marfatia Y. Clinico-epidemiological profile of HIV/TB coinfected patients in Vadodara, Gujarat. Ind J Sex Transmit Disea. 2009 Jan;30(1):10.
Bhal. Prevalence of HIV infections among patients of PTB attending attending chest Disease Hospital, Jammu (J and K); Ind J Com Med. Nov.2004;32:2007-10.
Mohanty KC, Sundrani RM. HIV Infection and AIDS in the developing world. BMJ. 16 June 2001;322.
Rajasekaran S, Uma A, Kamakshi S, Jeyaganesh D, Senthamizhchelvan A, Savithri S. Trend of HIV infection in patients with tuberculosis in rural south India. Ind J Tubercul. 2000;47(4):223-6.
Agarwal SK, Makhija A. Tuberculosis in HIV/AIDS Patients in A Territory Care Hospital in Delhi. Ind. J. Tub., 2003;50:163.
Amballi AA. Demographic pattern and haematological profile in a PLHA’s in a university teaching hospital; scientific research and essay. 2007;2(8):315-8.
Amanda M. AIDS primary health care and health management. 1996;10:1057-65.
WHO. Global programme on AIDS: The HIV/AIDS pandemic, WHO. 1993;1:1-2.
Khandekar MM, Desh Mukh SD, Bhore AV. Hematological profile of HIV positive pregnant women: Int Conf AIDS. 2004 Jul 11-16;15.
Murphy MF, Metcalfe P, Waters AH, Carne CA, Weller IV, Linch DC, et al. Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Brit J haematol. 1987 Jul;66(3):337-40.
Ogun SA, Adelavo OO, Faniloni OB. Spectrum and outcome of clinical disease in adults living with AIDS at Ogun university teaching hospital. East Afr Med J. 2003;80(10):513-8.
Erhabor O. Effect of Highly Active Anti-Retroviral Therapy (HAART) of stavudine, lamivudine on the CD4 lymphocyte count of HIV infected persons in Nigeria; 2006. Available at: www.ncbi.nlm.nih.gov/pubmed/17319344.
Patwardhan MS, Gowilkar AS, Abhayankar JR, Atre MC. Haematological profile of HIV positive patients. Ind J Pathol Microbiol. 2002;45:147-50.
Attili SV, Singh VP, Rai M, Varma DV, Gulati AK, Sundar S. Hematological profile of HIV patients in relation to immune status-a hospital-based cohort from Varanasi, North India. Turk J Hematol. 2008 Mar 5;25(1):13-9.
Gill Cunha de Santis. Haematological abnormalities in HIV infected patients. Int J Inf Diseas. December 2011;15(12). Available at: www.sciencedirect.com/science/article/pii/S1201971211001561.