Hematological manifestations of human immunodeficiency virus infection and the effect of highly active anti-retroviral therapy on cytopenia

Abstract

BackgroundThe aim of this study is to investigate the hematological manifestations of human immunodeficiency virus (HIV) infection, the risk factors for cytopenia, and the effect of highly active anti-retroviral therapy (HAART) on cytopenia.MethodsMedical records of patients treated for HIV at the Seoul National University Hospital from January 2005 to March 2010 were retrospectively reviewed. To determine the impact of HIV itself, we excluded HIV patients who had other conditions that could have resulted in hematological manifestations. Multiple logistic regression analyses were performed to identify risk factors for cytopenia.ResultsA total of 621 cases were investigated, and after exclusion, data of 472 patients were analyzed. The frequency of cytopenia was anemia, 3.0% (14/472); neutropenia, 10.0% (47/472); thrombocytopenia, 2.4% (12/472); lymphopenia, 25.7% (121/470); isolated cytopenia, 11.2% (53/472); and bicytopenia, 2.1% (10/472). The leading risk factor for cytopenia identified by multivariate logistic regression methods was AIDS status at initial presentation. After HAART, cytopenia was reversed in the majority of patients (thrombocytopenia, 100%; neutropenia, 91.1%; and anemia, 84.6%).ConclusionThis study isolated the impact of HIV infection alone on hematologic manifestations and confirmed that these changes were reversible by HAART. Control of the HIV infection will have the main role in the management of hematological manifestations of the virus.

Prevalence and associated factors of thrombocytopenia among human immunodeficiency virus-infected patients at a tertiary care hospital in İzmir, Turkey

“…Regarding the relationship between thrombocytopenia and plasma HIV-RNA levels, however, reports are not consistent (6,25,31,(36)(37)(38). Similar to these findings, in our study, patients with thrombocytopenia had a significantly lower median CD4+ T lymphocyte count than the control group (P < 0.05), but the median plasma HIV-RNA levels were similar between the 2 groups (P > 0.05).…”

“…The rate was higher in males than females (18,19,26). Regarding age, however, there was no consistency among studies (3,18,(31)(32)(33)(34). In our study, the 2 groups were similar regarding sex and age.…”

A cross-sectional study of leukopenia and thrombocytopenia among Chinese adults with newly diagnosed HIV/AIDS

“…Multiple interacting factors contribute to the hematological manifestations of HIV disease, it could be due to direct effects of HIV infection, opportunistic infections, lymphomas, malignancy or side effects of therapy. A study isolated the impact of HIV infection alone on hematologic manifestations and confirmed that these changes were reversible by ART (12). Therefore, control of the HIV infection will have the main role in the management of hematological manifestations of HIV.…”

“…The study in Uganda showed that the presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index. An investigation in South Korea found that the leading risk factor for cytopenia was AIDS status at initial presentation (12). Another study showed that neutropenia was associated with CD4 and platelet counts; and that thrombocytopenia was associated with country, gender, and chronic hepatitis B infection (16).…”

Chronic HIV disease and activation of the coagulation system

“…The classic hematologic complications described early in the HIV/AIDS treatment era largely constituted thrombocytopenia, anemia, and neutropenia attributable, in part, to increased consumption, concurrent infections, bone marrow suppression and/or ART drug toxicity (e.g., zidovudine) [1]. More widespread use of less toxic ART has reduced cytopenias among an HIV population that is now largely treated with corresponding viral suppression where access to antiretroviral therapy is present [2, 3]. …”