Hematological alterations associated with antiretroviral therapy in patients with human immunodeficiency virus
DOI:
https://doi.org/10.56294/saludcyt2022208Keywords:
Anemia, HIV, Leukopenia, Thrombocytopenia, Antiretroviral TherapyAbstract
Introduction: hematological alterations are very frequent and of multifactorial origin, they have been related to an increased risk of pathology progression and morbimortality in patients infected by the human immunodeficiency virus. Although there is a wide variety of scientific studies on the prevalence and pathogenesis of these alterations in HIV-positive patients, there are few investigations in our environment that report on the positive or negative effect of the administration of antiretroviral drugs.
Objective: to determine the main hematologic alterations associated with antiretroviral therapy in patients infected by the human immunodeficiency virus.
Method: narrative bibliographic review. The following databases were used for the research: PubMed, Cochrane and Scopus.
Results: the prevalence of at least one hematological alteration was 1,1-58,6 % among HIV-infected patients receiving ART. The most frequent cytopenia was anemia followed by leukopenia and thrombocytopenia. Among the most significant risk factors, patients older than 50 years, female sex, zidovudine-based antiretroviral regimen, low BMI and CD4 T-cell count, high viral load, advanced stage and opportunistic infections were identified.
Conclusions: the toxicity of antiretroviral drugs and the clinical conditions of the HIV-positive patient result in altered hematopoiesis affecting all three cell lines, patients may present with anemia, leukopenia, thrombocytopenia and/or pancytopenia. Failure to monitor and identify these disorders has a serious impact on the natural history of the disease in the patient
References
1. UNAIDS. Global HIV & AIDS statistics — Fact sheet 2022:6.
2. van Welzen BJ, Oomen PGA, Hoepelman AIM. Dual Antiretroviral Therapy—All Quiet Beneath the Surface? Frontiers in Immunology 2021;12:280. https://doi.org/10.3389/fimmu.2021.637910.
3. Tamir Z, Alemu J, Tsegaye A. Anemia among HIV Infected Individuals Taking ART with and without Zidovudine at Addis Ababa, Ethiopia. Ethiopian Journal of Health Sciences 2018;28:73. https://doi.org/10.4314/EJHS.V28I1.9.
4. Marchionatti A, Parisi MM. Anemia and thrombocytopenia in people living with HIV/AIDS: a narrative literature review. International Health 2021;13:98-109. https://doi.org/10.1093/INTHEALTH/IHAA036.
5. Ezeamama AE, Sikorskii A, Bajwa RK, Tuke R, Kyeyune RB, Fenton JI, et al. Evolution of Anemia Types During Antiretroviral Therapy—Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults. Nutrients 2019;11:755. https://doi.org/10.3390/NU11040755.
6. Woldeamanuel GG, Wondimu DH. Prevalence of thrombocytopenia before and after initiation of HAART among HIV infected patients at black lion specialized hospital, Addis Ababa, Ethiopia: A cross sectional study. BMC Hematology 2018;18:1-6. https://doi.org/10.1186/s12878-018-0103-6.
7. Bisetegn H, Ebrahim H. The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis. PLoS ONE 2021; 16(9):e0257630. https://doi.org/10.1371/JOURNAL.PONE.0257630.
8. Cao G, Wang Y, Wu Y, Jing W, Liu J, Liu M. Prevalence of anemia among people living with HIV: A systematic review and meta-analysis. eClinicalMedicine 2022;44:101283. https://doi.org/10.1016/j.eclinm.2022.101283.
9. Duguma N, Kiya GT, Maleko WA, Bimerew LG. Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study. SAGE Open Medicine 2021;9:20503121211020176. https://doi.org/10.1177/20503121211020175.
10. Carvajal Alzate M, Lopez L, Sarmiento J, Ruiz C, Quintero D, Álvarez Hernández L, et al. Compromiso hematológico en pacientes con infección por virus de la inmunodeficiencia humana en un hospital universitario de la ciudad de Medellín, Colombia. Enfermedades Infecciosas y Microbiología 2020;40:130.
11. Damtie S, Workineh L, Kiros T, Eyayu T, Tiruneh T. Hematological Abnormalities of Adult HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Treatment at Debre Tabor Comprehensive Specialized Hospital, Northcentral Ethiopia: A Cross-Sectional Study. HIV/AIDS (Auckland, NZ) 2021;13:477. https://doi.org/10.2147/HIV.S308422.
12. Ogar CK, Abiola A, Yuah D, Ibrahim A, Oreagba IA, Amadi EC, et al. A Retrospective Review of Serious Adverse Drug Reaction Reports in the Nigerian VigiFlow Database from September 2004 to December 2016. Pharmaceutical medicine 2019;33:145-57. https://doi.org/10.1007/S40290-019-00267-2.
13. Khan K, Khan AH, Sulaiman SA, Ting Soo C, Akhtar A. Adverse Drug Reactions in HIV/AIDS Patients at a Tertiary Care Hospital in Penang, Malaysia. Japanese journal of infectious diseases 2016;69:56-9. https://doi.org/10.7883/YOKEN.JJID.2014.246.
14. Rather ZA, Chowta MN, Prakash Raju GJK, Mubeen F. Evaluation of the adverse reactions of antiretroviral drug regimens in a tertiary care hospital. Indian journal of pharmacology 2013;45:145-8. https://doi.org/10.4103/0253-7613.108294.
15. Zenebe WA, Anbese AT, Tesfaye TS. Anemia And Associated Factors Among Adult People Living With HIV/AIDS Receiving Anti-Retroviral Therapy At Gedeo Zone, SNNPR, Ethiopia, 2018. HIV/AIDS (Auckland, NZ) 2019;11:351. https://doi.org/10.2147/HIV.S220461.
16. Mengistu A, Egata G, Hawulte B, Markos M, Lolaso T. Anemia and Associated Factors Among Adults with Human Immune Deficiency Virus on Antiretroviral Therapy in Public Health Facilities of Kembata Tembaro Zone, Southern Ethiopia: A Cross-Sectional Study. HIV/AIDS (Auckland, NZ) 2020;12:341. https://doi.org/10.2147/HIV.S259259.
17. Leroi C, Balestre E, Messou E, Minga A, Sawadogo A, Drabo J, et al. Incidence of Severe Neutropenia in HIV-Infected People Starting Antiretroviral Therapy in West Africa. PLoS ONE 2017;12. https://doi.org/10.1371/JOURNAL.PONE.0170753.
18. Talargia F, Teshome Y, Aynalem YA, Asefa A. Prevalence of Leucopenia and Associated Factors before and after Initiation of ART among HIV-Infected Patients, North East Ethiopia: Cross-Sectional Study. Journal of Blood Medicine 2021;12:269. https://doi.org/10.2147/JBM.S306369.
19. Taiwo B, Yanik EL, Napravnik S, Ryscavage P, Koletar SL, Moore R, et al. Evidence for risk stratification when monitoring for toxicities following initiation of combination antiretroviral therapy. AIDS (London, England) 2013;27:1593. https://doi.org/10.1097/QAD.0B013E3283601115.
20. Kyeyune R, Saathoff E, Ezeamama AE, Löscher T, Fawzi W, Guwatudde D. Prevalence and correlates of cytopenias in HIV-infected adults initiating highly active antiretroviral therapy in Uganda. BMC Infectious Diseases 2014;14:496. https://doi.org/10.1186/1471-2334-14-496.
21. Prosperi MCF, Fabbiani M, Fanti I, Zaccarelli M, Colafigli M, Mondi A, et al. Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study. BMC infectious diseases 2012;12:296. https://doi.org/10.1186/1471-2334-12-296.
22. Bekolo CE, Sonkoue C, Djidjou H, Bekoule PS, Kollo B. Evaluating the utility of early laboratory monitoring of antiretroviral-induced haematological and hepatic toxicity in HIV-infected persons in Cameroon. BMC Infectious Diseases 2014;14:519. https://doi.org/10.1186/1471-2334-14-519.
23. Ako SE, Njunda LA, Akum EA, Benjamin PT, Eteneneng EJ, Bernard W, et al. Hematological Related Disorders and Transfusion of HIV Patients on Highly Active Antiretroviral Therapy (HAART) in the South West Region of Cameroon: Hematological Monitory Parameters for HIV Follow-Up. Journal of HIV & Retro Virus 2018;4(1):5. https://doi.org/10.21767/2471-9676.100037.
24. Ngongondo MN, Rosenberg NE, Stanley CC, Lim R, Ongubo D, Broadhurst R, et al. Anemia in people on second line antiretroviral treatment in Lilongwe, Malawi: A cross-sectional study. BMC Infectious Diseases 2018;18:1-8. https://doi.org/10.1186/S12879-018-2952-9/TABLES/3.
25. Lin L, Li TS. Multidisciplinary collaborative integrated management of increasingly prominent HIV complications in the post-cART era. HIV Medicine 2020;21:683-91. https://doi.org/10.1111/HIV.13022.
26. Katemba C, Muzoora C, Muwanguzi E, Mwambi B, Atuhairwe C, Taremwa IM. Hematological abnormalities in HIV-antiretroviral therapy naïve clients as seen at an immune suppression syndrome clinic at Mbarara Regional Referral Hospital, southwestern Uganda. Journal of blood medicine 2018;9:105-10. https://doi.org/10.2147/JBM.S157148.
27. Denue BA, Kida IM, Hammagabdo A, Dayar A, Sahabi MA. Prevalence of Anemia and Immunological Markers in HIV-Infected Patients on Highly Active Antiretroviral Therapy in Northeastern Nigeria. Infectious diseases 2013;6:25-33. https://doi.org/10.4137/IDRT.S10477.
28. Talargia F, Getacher L. Thrombocytopenia and Associated Factors Among HIV Infected Patients in Pre- and Post-Anti-Retroviral Therapy, North East Ethiopia. Journal of Blood Medicine 2021;12:741. https://doi.org/10.2147/JBM.S323086.
29. van der Heijden WA, van de Wijer L, Jaeger M, Grintjes K, Netea MG, Urbanus RT, et al. Long-term treated HIV infection is associated with platelet mitochondrial dysfunction. Scientific Reports 2021;11:1-12. https://doi.org/10.1038/s41598-021-85775-5.
30. Jin Y, Li Q, Meng X, Xu Q, Yuan J, Li Z, et al. Prevalence of anaemia among HIV patients in rural China during the HAART era. International Journal of STD and AIDS 2017;28:63-8. https://doi.org/10.1177/0956462415622866.
31. Gedefaw L, Yemane T, Sahlemariam Z, Yilma D. Anemia and Risk Factors in HAART Naïve and HAART Experienced HIV Positive Persons in South West Ethiopia: A Comparative Study. PLoS ONE 2013;8. https://doi.org/10.1371/JOURNAL.PONE.0072202.
32. Owiredu WKBA, Quaye L, Amidu N, Addai-Mensah O. Prevalence of anaemia and immunological markers among Ghanaian HAART-naïve HIV-patients and those on HAART. African Health Sciences 2011;11:2.
33. Johannessen A, Naman E, Gundersen SG, Bruun JN. Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania. BMC Infectious Diseases 2011;11:190. https://doi.org/10.1186/1471-2334-11-190.
34. Moore RD, Forney D. Anemia in HIV-infected patients receiving highly active antiretroviral therapy. Journal of acquired immune deficiency syndromes (1999) 2002;29:54-7. https://doi.org/10.1097/00042560-200201010-00007.
35. Rajesh R, Vidyasagar S, Varma DM, Mohiuddin S, Noorunnisa. Evaluation of incidence of zidovudine induced anemia in Indian human immunodeficiency virus positive patients in comparison with stavudine based highly active antiretroviral therapy. The International journal of risk & safety in medicine 2011;23:171-80. https://doi.org/10.3233/JRS-2011-0531.
36. 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. Antiviral therapy 2006;11:741-9. https://doi.org/10.1177/135965350601100612.
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Copyright (c) 2022 Carla María Taimal Sárez, Esteban Adrián Reiban Espinoza, Giselle Marina Flores Siranaula, Paul Alexis Chuquitarco Marín (Author)
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