Characteristics of Cytopenia in HIV Positive Individuals

Background: HIV infection is an emerging issue all over the world. Bangladesh also experiencing increasing trend of infection over the time. Around 9500 infected individuals were in 2014 and it were only 500 individuals in 2000. Haematological manifestations are very common among those individuals whereas cytopenia is the commonest. Cytopenia may develop due to HIV itself or its sequel or due to drugs used for treatment. In Bangladesh, there is no available data regarding cytopenia and its association in HIV positive individuals till date. So, in our study, we tried to focus about the frequency of cytopenia and its associated factor.

Objective: The objective of this study was to assess the characteristics of cytopenia in HIV positive individuals.

Methods: This was a cross sectional analytical study where 100 of HIV positive individuals were enrolled. The study was conducted in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with collaboration of Ashar Alo Society, Dhaka, a renowned NGO from January 2014 to December 2015. Cytopenia was identified by automated cell counter and re-evaluated by manual examination of peripheral blood film. CD4 count measured by flow cytometry. Multiple regression analysis was done to assess correlation of different variable. A p value of <0.05 was taken as significant.

Results: Among total participants, 56% had at least one type of cytopenia. Anaemia was observed in 45% whereas leucopenia and thrombocytopenia were found in 10% and 17% respectively. Among all anaemic individual’s, mild anemia was the commonest which was in 64.4%, 22% was moderately anemic and severe anemia was observed in 13.3 % cases. The most common type of anaemia was microcytic anaemia 51.1%, then normocytic anaemia was found in 44.4% while macrocytic variety were seen in only 4.4%. Bicytopenia was observed in 14% and only 1% had pancytopenia. Cytopenia were more prevalent in subjects aged between 20 and 40 years. Multiple regression analysis shows anemia was associated with gender (p <0.05) and CD4 count (p<0.0001). Thrombocytopenia was associated with CD4 count (p<0.05), leukopenia was correlated with the CD4 count (p<0.05) and age (p<0.05) among the variables observed. According to proportion of cytopenia after HAART, neutropenia was at baseline 46.6%, at 6 months 18.0%, at 12 months 15.1%. and at 24 months 11.3%. Anemia at baseline 57.1%, at 6 months 14.9%. after 12 months 9.2% and at 24 months 7.9%. Thrombocytopenia at baseline 19.3%, at 6 months 4.4%, at 12 months 4.3% and at 24 months 2.5%. Cytopenia at baseline 79.1%, at 6 months 25.4%, at 12 months 21.8% and at 24 months 17.7%. Finally, of bi-cytopenia baseline 18.2%, at 6 months 3.4%, at 12 months 2.6% and after 24 2% respectively.

Conclusion: Anemia is the commonest cytopenia related to HIV infected individuals. Mild anemia and microcytic type are very common in Bangladesh. CD4 count is a unique variable for development of cytopenia.