Details
Category: Volume 07 Issue 08 August 2019
Hits: 991

Title: Hematological Profile in Plwha Patients in relation to their CD4+ Count

Authors: Dr U.B. Padmanaban M.D, Dr M. Ramesh M.D, Dr Shruthi Sasikumar M.D

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.36

Abstract

Introduction

Global statistics say 36.7 million people are infected with HIV 1.8 million new cases every year. As per Indian statistics 2015 report, adults (14-49 yrs) HIV prevalence was estimated at 0.26%. HIV prevalence in males is 0.30% and females is 0.22%. In 2016, India had 80,000 new cases and 62,000 AIDS related deaths. In HIV patient the focus mostly falls on the white cell count especially the lymphocyte levels and CD4+ count. But it has been shown that cytopenias of all major cell lines exist in HIV patients. The incidence of various cytopenias correlate directly with the level of immunosuppression.

Isolated cytopenia, especially thrombocytopenia may even be the initial presentation of HIV.

References

  1. Sullivan PS, Hanson DL, Chu SY, et al. 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; 91:301.
  2. Berhane K, Karim R, Cohen MH, et al. Impact of highly active antiretroviral therapy on anemia and relationship between anemia and survival in a large cohort of Hiv-infected women: Women‘s interagency HIV Study. J Acquir Immune Defic Syndr 2004;37:1245.
  3. Cross Continents Collaboration for Kids analysis and writing committ Markers  for  predicting  mortality  in  untreated  HIV- infected children in resource-limited settings: a meta-analysis. AIDS 2008; 22:97.
  4. Sullivan PS, Hanson DL, Chu SY, et al. 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; 91:301.
  5. O‘Brien ME,  Kupka  R,  Msamanga  GI,  et  al.  Anemia  is  an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzani J Acquir Immune Defic Syndr 2005; 40:219.
  6. Redig AJ, Berliner N, Pathogenesis And clinical implications of HIV- related anemia in 2013. Hematology Am Soc Hematol Educ Program 2013; 2013:37
  7. Stebbing J, Pantawitz L, Dayyani F, et al. HIV associated multicentric Castleman‘s diseas Am J Hematol 2008;83:498.
  8. Hepburn MJ, Dyal K, Runer LA, et al. low serum B12 levels in an outpatient HIV-infected population. Int J STD AIDS 2004; 15;127.
  9. Richman DD, Fischl MA, Grieco MH, et al. the toxicity of Azidothymidine in the treatment of patients with AIDS and AIDS- related complex. A double-blind, placebo controlled trial. N Engl J Med 1987; 99:57.
  10. Eyer-silva WA, Arabe J, Pinto JF, Morais-De-Sa CA. Macrocytosis in paients on stavudin Scand J Infect Dis 2001; 33:386.
  11. Khawcharoenporn T, Shikuma CM, Williams AE, Chow D Lamivudine associated macrocytosis in HIV-infected patients. Int J STD AIDS 2007; 18:39.
  12. Snower DP, Weil SC. Changing etiology of macrocytosis. Zidovudine as a frequent causative factor. Am J Clin Patho 1993; 33:239.
  13. Doung M, Piroth L, Peytavin G, et al. Value of patient self-report and plasma human immunodeficiency virus protease inhibitor level as markers of adherence to antiretroviral therapy; relationship to virological respons Clin Infect Dis 2001; 33:386.
  14. Scadden DT, Zon LI, Groopman JE. Pathophysiology and management of HIV associated hematological disorders. Blood 1989; 74:1455.
  15. Shen H, Ghemg T, Preffer FL, et al. Intrinsic human immunodeficiency virud tpe 1 resistance of hematopoietic stem cells despite coreceptor expression. J Virol 1999; 73:728.
  16. Andersen CL, Tesfa D, Siersma VD, et al. Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study. J Intern Med 2016; 279:566.
  17. Firnhaber C, Smeaton L, Saukila N, et al. Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas. Int J Infect Dis 2010; 14:e1088.
  18. Levine AM,  Karim  R,  Mack  W,  et  al.  Neutropenia  in  human immunodeficiency  virus  infection:  data  from  the  women's interagency HIV study. Arch Intern Med 2006; 166:405.
  19. Leroi C,  Balestre  E,  Messou   E,  et   al.  Incidence  of  Severe Neutropenia in HIV-Infected People Starting Antiretroviral Therapy in West Afri PLoS One 2017; 12:e0170753.
  20. Murphy MF,   Metcalfe   P,   Waters   AH,   et   al.   Incidence   and mechanism of neutropenia and thrombocytopenia in patients with human  immunodeficiency  virus  infection.  Br  J  Haematol  1987; 66:337.
  21. Moore RD, Keruly JC, Chaisson RE. Neutropenia and bacterial infection in acquired immunodeficiency syndrom Arch Intern Med 1995; 155:1965.
  22. Keiser P,  Higgs  E,  Smith  J.  Neutropenia  is  associated  with bacteremia in patients infected with the human immunodeficiency virus. Am J Med Sci 1996; 312:118.
  23. Søgaard OS, Lohse N, Østergaard L, et al. Morbidity and risk of subsequent diagnosis of HIV: a population based case control study identifying indicator diseases for HIV infection. PLoS One 2012;7:e 32538.
  24. Lai SW,  Lin  HF,  Lin  CL,  Liao  K  Immune  thrombocytopenic purpura might be an early hematologic manifestation of undiagnosed human immunodeficiency virus infection. Intern Emerg Med 2017; 12:157.
  25. Galli M, Musicco M, Gervasoni C, et al. No evidence of a higher risk of progression to AIDS in patients with HIV-1-related severe thrombocytopeni J Acquir Immune Defic Syndr Hum Retrovirol 1996; 12:268.
  26. Wandt H, Frank M, Ehninger G, et al. Safety and cost effectiveness of a 10 x 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 x 10(9)/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemi Blood 1998; 91:3601.
  27. Ehmann WC, Rabkin CS, Eyster ME, Goedert JJ. Thrombocytopenia in HIV-infected  and  uninfected  hemophiliacs.  Multicenter Hemophilia Cohort study. Am J Hematol 1997; 54:296.
  28. Peltier JY, Lambin P, Doinel C, et al. Frequency and prognostic importance of thrombocytopenia in symptom-free HIV-infected individuals: a 5-year prospective study. AIDS 1991; 5:381.
  29. Glatt AE,  Anand  A.  Thrombocytopenia  in  patients  infected  with human immunodeficiency virus: treatment updat Clin Infect Dis 1995; 21:415.
  30. Cole JL,  Marzec  UM,  Gunthel  CJ,  et  al.  Ineffective  platelet production in thrombocytopenic human immunodeficiency virus- infected patients. Blood 1998; 91:3239.
  31. Dikshit B, Wanchu A, Sachdeva R K, Sharma A, Das R, et al. Profile Of Hematological Abnormalities Of Indian HIV Infected Individuals. BMC Blood Disord. 2009 Aug 13;9:5 doi:10.1186/1471-2326-9-
  32. Parinitha SS, Kulkarni MH, et al. Haematological Changes in HIV Infection With Correlation To CD4+ Cell count. Australas Med J. 2012 Mar;5(3);157-162 DOI:10.4066/AMJ.20121008.
  33. Suresh VSA, Singh VP, Rai M, Datla VV, Gulati AK, Shyam Hematological profile of HIV patients in Relation to immune status- a hospital based cohort from Varanasi North India. Turk J Hematol 2008 Jan; 25:13-19
  34. Amegor OF,  Bijila  DA,  Oyesola  OA,  Oyesola  TO,  Buseni  ST. Hematological  changes  in  HIV  patients  placed  on  Antiretroviral Therapy in Markurdi, Benue state of NigeriAsian Journal of Epid. 2009 feb. 2;4;97-103. Doi:10.3923/aje2009.97.103.
  35. Preeti BA, Sharda RR, Meenal VJ et al. Absolute lymphocyte count as a surrogate marker of cd4+ count in monitoring HIV infected individual; a prospective study. J Clin Diagn Res. 2016 May; 10(5); EC 17-EC19 doi;10.7860/JCDR/2016/19263.7765.
  36. AIDS/HIV-Brian Hoyle.Information Plus Reference SERIE Formerly Published by Information Plus, Wylie, Texas. http://www.bmj.com/content/340/bmj.c621
  37. "2.5 million people in India living with Aids, according to new estimates". New York Times. http://data.unaids. org/pub/ Press Release /2007/070706_indiapress-release_en.pd Retrieved 2007-06- 08.
  38. ."India sees 50% decline in new HIV infections: un report". Hindustan Times. http://www.hindustantimes.com/India-sees-50-decline-in- newhiv- infections-un-report/Article1-680333.aspx. Retrieved 2011- 04-02.
  39. Sternberg, Steve (2005-02-23). "HIV scars India". USA Today. http://www.usatoday.com/news/health/2005-02-23-aids-india_x.htm.
  40. "Health care fails to reach migrants". Hindustan Times. December 1, 2010.http://www.hindustantimes.com/Health-care-fails-to- reachmigrants / Article1-632918.asp
  41. CIA World Factbook publication- AIDS prevalence rates 8.
  42. National AIDS Control Organization (NACO) (1998–99) Country scenario. NACO,Ministry  of  Health  and  Family  Welfare, Government of India, New Delhi. National AIDS Control Organization  (NACO)  (1999)  India  responds  to  HIV/AIDS:  a strategic response to the HIV epidemic by the Government of India, the UN,and its development partners in India, 1999–2000. NACO, Ministry of Health and Family Welfare, Government of India, New Delhi.
  43. Changes  in   blood   coagulation   in   HIV   infection]Majluf-Cruz A.SolSherry Thrombosis Research Center, Temple University School of Medicine, Philadelphia, PA 19140, USA.
  44. Harrison‘s principles of internal medicine-18th editio

Corresponding Author

Dr M. Ramesh M.D