Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas.

TitleComparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas.
Publication TypeJournal Article
Year of Publication2010
AuthorsFirnhaber C, Smeaton L, Saukila N, Flanigan T, Gangakhedkar R, Kumwenda J, La Rosa A, Kumarasamy N, De Gruttola V, Hakim JGita, Campbell TB
JournalInt J Infect Dis
Volume14
Issue12
Paginatione1088-92
Date Published2010 Dec
ISSN1878-3511
KeywordsAdult, Africa, Americas, Anemia, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Asia, Caribbean Region, Developing Countries, Female, HIV Infections, HIV-1, Humans, Male, Neutropenia, Prevalence, South America, Thrombocytopenia, United States
Abstract

BACKGROUND: Hematological abnormalities are common manifestations of advanced HIV-1 infection that could affect the outcomes of highly-active antiretroviral therapy (HAART). Although most HIV-1-infected individuals live in resource-constrained countries, there is little information about the frequency of hematological abnormalities such as anemia, neutropenia, and thrombocytopenia among individuals with advanced HIV-1 disease.

METHODS: This study compared the prevalence of pre-antiretroviral therapy hematological abnormalities among 1571 participants in a randomized trial of antiretroviral efficacy in Africa, Asia, South America, the Caribbean, and the USA. Potential covariates for anemia, neutropenia, and thrombocytopenia were identified in univariate analyses and evaluated in separate multivariable models for each hematological condition.

RESULTS: The frequencies of neutropenia (absolute neutrophil count ≤1.3×10⁹/l), anemia (hemoglobin ≤10g/dl), and thrombocytopenia (platelets ≤125×10⁹/l) at initiation of antiretroviral therapy were 14%, 12%, and 7%, respectively, and varied by country (p<0.0001 for each). In multivariable models, anemia was associated with gender, platelet count, and country; neutropenia was associated with CD4+ lymphocyte and platelet counts; and thrombocytopenia was associated with country, gender, and chronic hepatitis B infection.

CONCLUSIONS: Differences in the frequency of pretreatment hematological abnormalities could have important implications for the choice of antiretroviral regimen in resource-constrained settings.

DOI10.1016/j.ijid.2010.08.002
Alternate JournalInt. J. Infect. Dis.
PubMed ID20961784
PubMed Central IDPMC3021118
Grant List1 U01AI069417-01 / AI / NIAID NIH HHS / United States
1U01 AI069424-01 / AI / NIAID NIH HHS / United States
1U01 AI069438-01 / AI / NIAID NIH HHS / United States
1U01 AI069463-01 / AI / NIAID NIH HHS / United States
1U01 AI069497-01 / AI / NIAID NIH HHS / United States
1U01 AI069518-011 / AI / NIAID NIH HHS / United States
1U01-AI069472-01 / AI / NIAID NIH HHS / United States
1U01AI069465-01 / AI / NIAID NIH HHS / United States
1U02 AI069439-01 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634-06 / AI / NIAID NIH HHS / United States
U01 AI069417-01 / AI / NIAID NIH HHS / United States
U01 AI069424 / AI / NIAID NIH HHS / United States
U01 AI069424-01 / AI / NIAID NIH HHS / United States
U01 AI069438 / AI / NIAID NIH HHS / United States
U01 AI069438-01 / AI / NIAID NIH HHS / United States
U01 AI069439 / AI / NIAID NIH HHS / United States
U01 AI069439-01 / AI / NIAID NIH HHS / United States
U01 AI069463 / AI / NIAID NIH HHS / United States
U01 AI069463-01 / AI / NIAID NIH HHS / United States
U01 AI069465 / AI / NIAID NIH HHS / United States
U01 AI069465-01 / AI / NIAID NIH HHS / United States
U01 AI069472 / AI / NIAID NIH HHS / United States
U01 AI069472-01 / AI / NIAID NIH HHS / United States
U01 AI069518 / AI / NIAID NIH HHS / United States
U01 AI069518-05 / AI / NIAID NIH HHS / United States
U01A1069436-01 / / PHS HHS / United States
UM1 AI069438 / AI / NIAID NIH HHS / United States