CORRELATIONS BETWEEN CLUSTER DIFFERENTIATION 4 COUNTS, HUMAN IMMUNODEFICIENCY VIRUS CLINICAL STAGES, AND HEMOGLOBIN LEVEL AMONG HUMAN IMMUNODEFICIENCY VIRUS PATIENTS WITH ANEMIA IN MERPATI CLINIC, WANGAYA HOSPITAL, DENPASAR, BALI, INDONESIA: A CROSS-SECTI

  • KETUT SURYANA Department of Internal Medicine, Wangaya HIV Study Group, Merpati Clinic, Wangaya Hospital, Denpasar, Indonesia.
  • HAMONG SUHARSONO Department of Biochemistry, Veterinary Faculty of Udayana University of Denpasar Indonesia.
  • GEDE BUDIASA Department of Clinical Pathology, Wangaya Hospital, Denpasar, Indonesia.
  • JARWA ANTARA Department of Internal Medicine, Medical Faculty of Udayana, University-Sanglah Hospital, Denpasar, Indonesia.
  • PUJI ASTUTI Department of Internal Medicine, Wangaya HIV Study Group, Merpati Clinic, Wangaya Hospital, Denpasar, Indonesia.
  • IDA AYU INDAH Department of Internal Medicine, Wangaya HIV Study Group, Merpati Clinic, Wangaya Hospital, Denpasar, Indonesia.
  • PUTRI STUTI Department of Internal Medicine, Wangaya HIV Study Group, Merpati Clinic, Wangaya Hospital, Denpasar, Indonesia.

Abstract

Objective: The objective of this study was to determine the correlation between cluster of differentiation 4 (CD4) counts, human immunodeficiency virus (HIV) clinical stages, and hemoglobin (Hb) level among HIV-infected patients with anemia.


Methods: A cross-sectional study was conducted in November 2017 at Merpati Clinic of Wangaya Hospital, Denpasar, Bali, Indonesia. We selected 79 HIV patients with anemia to participate in our study. We grouped CD4 counts into two categories: <200 cells/μL and ≥200 cells/μL, and we classified the HIV clinical stages into HIV and acquired immunodeficiency syndrome (AIDS).


Results: About 55.7% (44) of men and 44.3% (35) of women were participated in this study. As many as, 91.1% (72) of participants were AIDS patients. The mean Hb was 8.77 g/dl with SD 1.79 g/dl. 81% (64) of study participants were suffered from anemia on chronic disease or inflammatory anemia, and 19% (15) of study participants were suffered from iron deficiency anemia. The median for CD4 counts was 94 cells/μL (3–309 cells/μL) with as many as 78.5% (62) of participants were found to have low CD4 counts (<200 cells/μL). Spearman analysis revealed a positive correlation between CD4 counts and Hb level (r=0.427, p<0.001). Independent sample t-test analysis found a correlation between the HIV clinical stages and Hb level. There was a difference between the mean of Hb level in each stage with the average difference of 0.8 g/dl (95% confidence interval 0.04–1.6; p<0.04).


Conclusions: There is a correlation between CD4 counts, HIV clinical stages, and Hb level among HIV patients with anemia.

Keywords: Human immunodeficiency virus clinical stages, Cluster differentiation 4 counts, Anemia.

References

1. Zon LI, Arkin C, Groopman JE. Haematologic manifestations of the human immune deficiency virus (HIV). Br J Haematol 1987;66:251-6.
2. Kulkarni MB, Bhalerao MM, Dube SP. Anemia in people living with HIV/AIDS: A cross sectional study from India. IOSR J Dent Med Sci 2015;14:2279-861.
3. Coyle TE. Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med Clin North Am 1997;81:449-70.
4. Volberding PA, Levine AM, Dieterich D, Mildvan D, Mitsuyasu R, Saag M, et al. Anemia in HIV infection: Clinical impact and evidence-based management strategies. Clin Infect Dis 2004;38:1454-63.
5. Kreuzer KA, Rockstroh JK, Jelkmann W, Theisen A, Spengler U, Sauerbruch T, et al. Inadequate erythropoietin response to anaemia in HIV patients: Relationship to serum levels of tumour necrosis factor-alpha, interleukin-6 and their soluble receptors. Br J Haematol 1997;96:235-9.
6. World Health Organization. Worldwide Prevalence on Anaemia 1993-2005. Geneva: World Health Organization; 2008.
7. Hambleton J. Hematologic complications of HIV infection. Oncology (Williston Park) 1996;10:671-80.
8. Owiredu WK, Quaye L, Amidu N, Addai-Mensah O. Prevalence of anaemia and immunological markers among ghanaian HAART-naïve HIV-patients and those on haart. Afr Health Sci 2011;11:2-15.
9. Subbaraman R, Devaleenal B, Selvamuthu P, Yepthomi T, Solomon SS, Mayer KH, et al. Factors associated with anaemia in HIV-infected individuals in southern india. Int J STD AIDS 2009;20:489-92.
10. Berhane K, Karim R, Cohen MH, Masri-Lavine L, Young M, Anastos K, 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;37:1245-52.
11. Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. 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;91:301-8.
12. Buskin SE, Sullivan PS. Anemia and its treatment and outcomes in persons infected with human immunodeficiency virus. Transfusion 2004;44:826-32.
13. Ssali F, Stöhr W, Munderi P, Reid A, Walker AS, Gibb DM, et al. Prevalence, incidence and predictors of severe anaemia with zidovudine-containing regimens in african adults with HIV infection within the DART trial. Antivir Ther 2006;11:741-9.
14. Moses A, Nelson J, Bagby GC Jr. The influence of human immunodeficiency virus-1 on hematopoiesis. Blood 1998;91:1479-95.
15. Koduri PR, Singa P, Nikolinakos P. Autoimmune hemolytic anemia in patients infected with human immunodeficiency virus-1. Am J Hematol 2002;70:174-6.
16. Belperio PS, Rhew DC. Prevalence and outcomes of anemia in individuals with human immunodeficiency virus: A systematic review of the literature. Am J Med 2004;116 Suppl 7A:27S-43S.
17. Bain BJ. Pathogenesis and pathophysiology of anemia in HIV infection. Curr Opin Hematol 1999;6:89-93.
18. Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, et al. Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women’s interagency HIV study. J Acquir Immune Defic Syndr 2001;26:28-35.
19. Semba RD, Shah N, Klein RS, Mayer KH, Schuman P, Vlahov D, et al. Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and uninfected women. Clin Infect Dis 2002;34:260-6.
20. Richman DD, Fischl MA, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 1987;317:192-7.
21. Volberding PA, Lagakos SW, Koch MA, Pettinelli C, Myers MW, Booth DK, et al. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS clinical trials group of the national institute of allergy and infectious diseases. N Engl J Med 1990;322:941-9.
22. Obirikorang C, Yeboah FA. Blood haemoglobin measurement as a predictive indicator for the progression of HIV/AIDS in resource-limited setting. J Biomed Sci 2009;16:102.
23. Paras Z, Waran M, Tyagi A. A study of prevalence of anemia among HIV patients and its correlation with clinical stage of AIDS, CD4 count and antiretroviral therapy. Int J Med Sci Clin Invent 2017;4:2538-43.
24. Moore RD, Keruly JC, Chaisson RE. Anemia and survival in HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 1998;19:29 33.
25. Ledru E, Diagbouga S, Meda N, Sanou PT, Dahourou H, Ledru S, et al. A proposal for basic management of HIV disease in West Africa: Use of clinical staging and haemogram data. Int J STD AIDS 1998;9:463-70.
26. Alavi SM, Ahmadi F, Farhadi M. Correlation between Total Lymphocyte Count, Hemoglobin, Hematocrit and CD4 Count in HIV/AIDS Patients. Acta Medica Iranica 2009;47:1-4.
27. Mathews SE, Srivastava D, Balayadav R, Sharma A. Association of hematological profile of human immunodeficiency virus-positive patients with clinicoimmunologic stages of the disease. J Lab Physicians 2013;5:34-7.
28. Ako SE, Njunda LA, Akum EA, Benjamin PT, Eteneneg EJ, Bernard W, et al. Hematological related disorders and transfusion of HIV patients on highly active antiretroviral therapy (HARRT) in the South West Region of Cameroon: Hematological Monitory Parameters for HIV Follow-Up. J HIV Retrovirus 2018;4:1-9.
29. Kathuria S, Bagga PK, Malhotra S. Hematological manifestations in HIV infected patients and correlation with CD4 counts and anti retroviral therapy. Int J Contemp Med Res 2016;3:3495-8.
30. Thulasi RR, Manimaran D, Hemanathan G, Tameem A, Radha S. Hematological abnormalities in HIV infected individuals in correlation to CD4 counts and ART status. Asian J Med Sci 2016;7:14-8.
31. Mehta S, Jutur S, Gautam. Hematological manifestations of HIV/AIDS. Med Update 2011:483-90. Available from: https://www.semanticscholar.org/paper/Hematologic-Manifestations-of-HIV-%2F-AIDS-Mehta-Jutur/4560ee231345f13a0c86e63616848a38a228f8ec
32. Kasthuri AS, Sharma S, Kar PK. A Study of Hematological manifestations of HIV infection. Indian J Sex Transm Dis 2006;27:9 16.
33. De Santis GC, Brunetta DM, Vilar FC, Brandão RA, de Albernaz Muniz RZ, de Lima GM, et al. Hematological abnormalities in HIV-infected patients. Int J Infect Dis 2011;15:e808-11.
34. Kumar MB, Thippeswamy T, Shankar R, Prathima C. Hematological abnormalities in ealry and advanced HIV infection patients. Int J Sci Stud 2016;3:1-11.
35. Dikshit B, Wanchu A, Sachdeva RK, Sharma A, Das R. Profile of hematological abnormalities of Indian HIV infected individuals. BMC Blood Disord 2009;9:5.
36. Addis Z, Yitayew G, Tachebele B. Prevalence of some hematological abnormalities among HIV positive patients on their first visit to a tertiary health instituion in Ethiophia; a cross sectional study. Int Blood Res Rev 2014;2:270-8.
37. Munyazesa E, Emile I, Multimura E, Hoover DR, Shi Q, McGinn AP, et al. Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: A cross-sectional study. BMJ Open 2012;2:1-8.
38. Opie J. Haematological complications of HIV infection. S Afr Med J 2012;102:465-8.
39. Afari SK, Blay EA. Prevalence of hametological and serum biochemical abnormalities in HIV infected patients in Ghana, before and after Antiretroviral Therapy. Int J Virol AIDS 2018;5:1-10.
40. Ezeonwu BU, Ikefuna AN, Oguonu T, Okafor HU. Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu. Niger J Clin Pract 2014;17:303-8.
41. Shruthi MS, Elavarasan T, Puvitha RD. Hematological profile of people living with HIV infection in government Dharmapuri medical college, Dharmapuri. Int Arch Integr Med 2017;4:228-33.
42. Parinitha S, Kulkarni M. Haematological changes in HIV infection with correlation to CD4 cell count. Australas Med J 2012;5:157-62.
43. Robinson O, Obianime AW, Aprioku J, Tamuno I. Immunological and hematological profile of HIV patients on anti-retroviral therapy in Port Harcourt Rivers State, Nigeria. Int Blood Res Rev 2017;7:1-12.
44. Redig AJ, Berliner N. Pathogenesis and clinical implications of HIV-related anemia in 2013. Hematology Am Soc Hematol Educ Program 2013;2013:377-81.
45. Assefa M, Abegaz WE, Shewamare A, Medhin G, Belay M. Prevalence and correlates of anemia among HIV infected patients on highly active anti-retroviral therapy at Zewditu memorial hospital, Ethiopia. BMC Hematol 2015;15:6.
46. Dinakar KR, Narendranath S, Vaneet A, Reshma SR, Somashekar HS, Keerthisagar JL. Changes in the CD4 counts, hemoglobin and weight in patients with HIV alone and HIV TB co-infection. Asian J Pharm Clin Res 2014; 7 Suppl 2:35-8.
47. Bhatnagar S, Sharma H, Sharma VK. Study of adverse effects of anti retroviral therapy in HIV naïve patients and their association with CD4 cell count. Asian J Pharm Clin Res 2013;6 Suppl 5:122-3.
Statistics
6 Views | 21 Downloads
How to Cite
SURYANA, K., H. SUHARSONO, G. BUDIASA, J. ANTARA, P. ASTUTI, I. A. INDAH, and P. STUTI. “CORRELATIONS BETWEEN CLUSTER DIFFERENTIATION 4 COUNTS, HUMAN IMMUNODEFICIENCY VIRUS CLINICAL STAGES, AND HEMOGLOBIN LEVEL AMONG HUMAN IMMUNODEFICIENCY VIRUS PATIENTS WITH ANEMIA IN MERPATI CLINIC, WANGAYA HOSPITAL, DENPASAR, BALI, INDONESIA: A CROSS-SECTI”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 3, Feb. 2019, pp. 426-9, https://innovareacademics.in/journals/index.php/ajpcr/article/view/30794.
Section
Original Article(s)