Anaemia in HIV infected HAART naïve and HAART exposed children

Authors

  • Ajey Sule Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India
  • Rajesh Kishanrao Kulkarni Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India
  • Aarti Kinikar Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India
  • Chhaya Valvi Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India
  • Uday Rajput Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India
  • Rahul Dawre Department of Pediatrics, B. J. Government Medical College, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20183540

Keywords:

Anaemia, Children, HIV infection, HAART, Opportunistic infections, Vegetarian

Abstract

Background: The 2016 UNAIDS report estimates about 2.1 million people living with HIV in India, of whom about 7 per cent are children under the age of 15 year. The primary objective of this study was to analyze the prevalence of anaemia in HIV Infected HAART naïve and HAART exposed children. The secondary objectives were to analyze the type of anaemia and correlation of anaemia with dietary habits and associated opportunistic infections. Present study was a cross-sectional, observational study carried out in pediatric ART OPD and ward of a tertiary care teaching hospital, from June 2011 to May 2013.

Methods: Complete haemogram, peripheral smear and CD4 counts were done on 130 children with confirmed diagnosis of HIV infection. CDC staging was used to stratify children. We used Chi square test to determine the association between CDC staging, HAART therapy, diet and opportunistic infection with anaemia. P-value <0.05 was taken as significant.

Results: 80% (n = 27) of the children with no immunosuppression, 86% (n = 58) of the children with moderate immunosuppression and 84% (n = 24) children with severe immunosuppression were anemic. There was no statistically significant relation between worsening immunosuppression and prevalence of anaemia (p = 0.715). 88% of the children with no opportunistic infection (n = 72) were anemic, while 76% (n = 34) children with opportunistic infection were anemic. This difference was statistically significant (p = 0.016). 88% (n = 53) of the children on HAART were anemic while 74% (n = 51) of the children not on HAART were anemic. Children on HAART did not have significantly high prevalence of anaemia when compared to children not on HAART (p = 0.99). Anaemia was significantly more common in children consuming vegetarian diet (88%, n = 46) compared to children consuming mixed diet (74%, n = 58, p <0.01).

Conclusions: Prevalence of anaemia is similar in children on HAART compared to HAART naïve children and at all stages of immunosuppression. Anaemia was more common in the presence opportunistic infections and in children consuming vegetarian diet. Microcytic hypochromic anemia was most common type of anaemia followed by normocytic normochromic anaemia.

References

UNAIDS. Global AIDS update. 2016. Available at http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf

National AIDS Control Organization. Guideline for HIV care and treatment in infant and children. 2006. Available at http://apps.who.int/medicinedocs/documents/s18022en/s 18022en.pdf

Claster S. Biology of anemia, differential diagnosis, and treatment options in HIV infection. J Infect Dis. 2002;185(2):S105-9.

Coyle TE. Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Med Clin North Am. 1997;81(2):449-70.

Shet A, Mehta S, Rajagopalan N. Anaemia and growth failure among HIV-infected children in India: A retrospective analysis. BMC Pediatr. 2009;9:37.

Adetifa IM, Temiye EO, Akinsulie AO. Haematological abnormalities associated with pediatric HIV/AIDS in Lagos. Ann Trop Paediatr. 2006;26:121-5.

Erhabor O, Ejele OA, Nwauche CA. Some hematological parameters in Human Immunodeficiency Virus (HIV) infected Africans. the Nigerian perspective. Niger J Med. 2005;14:33-8.

Chellan RR, Lopamudra P. Prevalence of iron-deficiency anaemia in india: results from a large nationwide survey. J Population Soc Studies. 2010;19:59-80.

Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, Colebunders R, et al. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. Euro SIDA study group. AIDS. 1999;13:943-50.

Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of Anaemia 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.

Spivak JC, Barnes DC, Fuchs E. Serum immunoreactive erythropoietin in HIV-infected patients. JAMA. 1989;261:3104-7.

Folks TM, Kessler A, Orenstein JM. Infection and replication of HIV-1 in purified progenitor cells of normal human bone marrow. Sci. 1988;242:919-22.

McKinney RE, Maha MA, Connor EM. A multicentric trial of oral zidovudine in children with advanced human immuno-deficiency virus disease. N Engl J Med. 1991;324:1018-25.

Medina I, Mills J, Leoung G. Oral therapy for pneumocystis carinii pneumonia in the acquired immune deficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone. N Engl J Med. 1990;323:776-82.

Hawkins CC, Gold JW, Whimbey E. Mycobacterium avium complex infections in patients with acquired immunodeficiency syndrome. Ann Intern Med. 1986;105:184-8.

Mitchell SA, Welch JM, Smith WS. Persistent B 19 parvovirus infection in a patient with AIDS: case report. Genitourin Med. 1990;66:95-6.

McGinniss M, Macher AA, Rook A. Red cell autoantibodies in patients with acquired immunodeficiency syndrome. Transfusion. 1986;26:405-9.

Assefa M, Abegaz W, Belay M. Prevalence and correlates of anaemia among HIV infected patients on HAART at Zewditu Memorial Hospital, Ethiopia. BMC Hematol. 2015;15:6.

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Published

2018-08-24

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Original Research Articles