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

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.

Trial registration: ClinicalTrials.gov NCT00084136.

Conflict of interest statement

Conflict of interest: None of the authors have any conflict of interest to declare.

Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1

Prevalence of hematological abnormalities prior to initiation of antiretroviral therapy, by country. (A) Anemia, defined as a hemoglobin ≤10.0 g/dl. (B) Neutropenia, defined as an absolute neutrophil count ≤1.3 × 109/l. (C) Thrombocytopenia, defined as a platelet count less than 125 × 109/l.