ORIGINAL

Niger J Paed 2015; 42 (2): 103 –106

Umar IU

Hassan-Hanga F

Ibrahim M

Prevalence of anaemia in paediatric

patients with HIV infection in Kano

DOI:http://dx.doi.org/10.4314/njp.v42i2.6

Accepted: 19th January 2015

Abstract: Background: HIV in-

fection affects virtually all sys-

tems of the body including the

haematological system.

Objective: To determine the

prevalence of anaemia in HIV

infected children and compare

with apparently healthy HIV

negative age-sex matched con-

trols.

present in 88.0% of the HIV-

infected children, compared to

15.0% of controls (p = 0.001).

Mild anaemia (70 – 109 g/L) was

observed in 85.0% of HIV-

infected children, compared to

15.0% of controls. Moderate anae-

mia (50 – 69 g/L) was present in

3.3% of HIV-infected children, but

in none of the control. Leucopenia

(

)

Umar IU

Hassan-Hanga F, Ibrahim M

Department of Paediatrics,

Aminu Kano Teaching Hospital

Kano, Nigeria.

Email: umarpaed@gmail.com

9

Design: Case control hospital-

based study.

(˂4 × 10 /L) was seen in 11.6% of

HIV-infected children and in 5.0%

Methods: A total of 60 confirmed

HIV infected antiretroviral naïve

children and 60 HIV negative

children were enrolled in a case

control study of baseline haemato-

logical indices. In all cases, hae-

moglobin, total white blood cell

count, neutrophils, lymphocytes

and platelet counts were deter-

mined using SYSMEX XT- 2000i

Haematologic auto-analyser. Chil-

dren with HIV/AIDS were classi-

fied according to clinical disease

stages using the 2006 World

Health Organization (WHO) stag-

ing criteria. Data was analysed

using MINITAB 12.21 Atlanta

USA statistical software.

of controls. Neutropenia (˂1.5 ×

10 /L) affected13% of infected

9

children and 5% ofcontrols. Lym-

9

phocytopenia (˂1.2 × 10 /L) was

observed in 3.3% of infected chil-

dren but in none ofcontrols. Corre-

sponding figures for thrombocyto-

9

penia (˂100 × 10 /L) were6.7% of

HIV infected children and 1.7% of

controls.

Conclusion: All cells lines

arereduced in HIV/AIDS and

anaemia is the most frequent hae-

matological manifestation seen in

HIV/AIDS infection.

Key words: Prevalence, Anaemia;

HIV, Paediatrics, Patients

Result: Anaemia (˂110 g/L) was

Introduction

infection is essential to correcting these cytopenias, in

addition to identifying precipitating factors and provid-

ing supportive care. Supportive care based on the level

of severity may include the use of haematinics, erythro-

poietin, myeloid growth factors (GM-CSF) in addition

to the judic₈_-i₁o₁us use of red blood cell transfusions in se-

vere cases . This study was undertaken to determine

the prevalence of anaemia in children presenting with

HIV infection in comparison with apparently healthy

HIV negative children.

The HIV/AIDS scourge is a serious threat to the physi-

cal, social and economic development of affected coun-

tries, particularly the low resource, under developed

countries. Virtually all systems are affected in HIV in-

fection and the haematological system is one of the early

systems affected, resulting in early death or impaired

quality of life . Cytopenias in HIV infection are gener-

ally caused by inadequate production due to suppression

of bone marrow by the HIV through abnormal expres-

sion of cytokines and alteration of the bone marrow mi-

1

,2

2

-4

croenvironment . Thrombocytopenia is caused by im-

mune-mediated destruction of platelets, in addition to

Subjects and Methods

4

-8

inadequate platelet production . Other causes of cyto-

penias include adverse effects of drug therapy and sec-

onda_,r₄y_,₆effects of opportunistic infections and malignan-

The study was conducted between the months of

November 2009 and April 2010. Sixty antiretroviral-

naïve, HIV positive children between the ages of 3

2

cies . Optimal management of the underlying HIV

1

04

months to 14 years referred to the Paediatric HIV clinic

were enrolled, and sixtyage-sex matched HIV negative

children in apparently good health, without any clini-

cally observed acute or chronic illness were enrolled as

controls. Informed consent was secured from the par-

ents/guardians of all the patients. Ethical clearance was

obtained from the Research and Ethics Committee of

Aminu Kano Teaching Hospital (AKTH) before the

study was commenced.

Fig 1: Frequency of cytopenias in HIV positive and con-

trol children

Laboratory analyses were conducted at the Federal Min-

istry of Health (FMOH) approved specialist laboratory

of AKTH. Specimens for full blood count was analysed

using the haematology auto-analyser SYSMEX XT –

2

000i. In an effort to exclude some common causes of

anaemia, haemoglobin genotype, blood film for malaria

and stool microscopy for hookworm were done to ex-

clude subjects with sickle cell anaemia, malaria and

hookworm infestation.

(Leuco= leucopenia, Neutro=neutropenia, Lympho= lympho-

cytopenia, Thrombo= thrombocytopenia)

The prevalence of anaemia was significantly higher in

HIV-affected children than in controls [53 (88.3%) ver-

sus 9 (15.0%), χ = 64.61 p = 0.001.

In comparing the mean haemoglobin level between the

HIV infected and controls, a significant difference was

observed. Also the mean level of leucocytes, neutro-

phils, lymphocytes and platelets are lower in infected

children than control (Table 2).

Demographic data, haemoglobin level, total white blood

cell count, absolute neutrophil and lymphocyte count,

platelet count were obtained. . Children with HIV/AIDS

were classified according to clinical disease stages using

the 2006 World Health Organization (WHO) staging

criteria. Anaemia was defined as haemoglobin (Hb)

2

<

moderate and < 50 g/L as severe anaemia . Leucopenia

110 g/L: 70 – 109g/L as mild anaemia, 50 – 69g/L as

12

9

de₃fined as a total white blood cell count of < 4 × 10 /

1

Table 2: Haematological indices of HIV infected compared

with HIV uninfected children

L . Neutropenia defined as an absolute neutrophil

9

13

count (ANC) of < 1.5 × 10 /L. Lymphocytopenia de-

f₁i₃ned as an absolute lymphocyte count of < 1.2 × 10 /L.

9

Mean (SD)

HIV-infected

Non-infected

t-test

p-value

Hematological Indices

Thrombocytopenia defined as a platelet count of <

9 14

00 × 10 /L .

Haemoglobin concen-

tration(g/L)

1

93.8 (13.3)

7.19 (2.09)

119 (11.9)

9.40 (4.86)

10.95

3.25

0.001

0.002

9

Total WBC (× 10 /L)

9

Statistical analysis

Neutrophils (× 10 /L)

2.88 (1.08)

3.88 (1.72)

325(892.4)

3.72 (2.83)

4.52 (2.58)

336(162.3)

2.14

1.59

2.12

0.036

0.11

9

Lymphocytes(× 10 /L)

9

Platelets (×10 /L)

0.037

Data entry, analyses and validation were done using

MINITAB 12.21 Atlanta USA statistical software.

Quantitative variables were summarized using mean and

standard deviation and means were compared using Stu-

dent’s – t-test. Chi-square test of statistical significance

was used to compare categorical variables. Probability

value (p-value) of less than 0.05 was considered as sig-

nificant.

WBC = white blood cell

SD = standard deviation

Discussion

Anaemia was the most common identified haematologi-

cal manifestation of HIV infection affecting88% of HIV

infected children and only 15% of controls. The high

prevalence of anaemia observed is similar to that of

Adetifa et al who reported 77.9% of anaemia in HIV

Results

There were 39 males and 21 females in each group of 60

HIV-infected and 60 controls, giving a male: female

ratio of 1.9:1. The mean age of the males and the fe-

males were 39.9 (±31.3) and 70.7 (±46.7) months re-

spectively. The mean weight in the HIV-infected group

was 13.11 (±7.40) kg and that of control group was

1

5

infected children in Lagos and Ellaurie et al who

5

reported 94% in infected infants in New York . How-

ever, the findings in the current study are more likely

reflective of myelosuppressive effects of HIV infection

because other diseases were excluded, such as sickle cell

disease, malaria and hookworm infestation. The HIV

virus may impair the survival and proliferative capacity

of haematopoietic progenitor cells that differentiate to

1

4.94 (±6.70) kg (p = 0.16). The mean height of the HIV

-

(

infected group was also comparable to that of controls

90.5 ±23.0cmversus 91.2 ±22.0cm, p = 0.85). Based on

8

produce the peripheral blood cells , in addition to blunt-

WHO clinical staging, 35 (58.4%) of the HIV-infected

children belonged to stages 1 and 2 while 25 (41.6%)

belonged to stages 3 and 4. Anaemia was the

ing production of erythropoietin in anaemic HIV-

infected patients, similar to the suppression seen in other

1

6

states of chronic infection or inflammation .

commonest haematological abnormality observed

Mild and moderate anaemia were seen in infected chil-

1

05

1

9

dren in this study but only mild anaemia was observed

in the controls. A similar observation was made in a

systematic review from a global perspective involving

fifteen studies, where mild and moderate anaemia were

more prevalent with HIV infection in both western₇and

advanced disease . Because HIV causes decreased col-

ony growth of the committed progenitor cell, CFU-GM,

leading to decreased production of both gran₉ulocytes,

1

monocytes and other types of white blood cells .

Thrombocytopenia was observed more in infected chil-

dren than the controls. Also previous studies in children

demons₂t₂r_,a₂₃ted thrombocytopenia in those with HIV in-

1

tropical settings, constituting 73% to 100% of cases .

There was no documented case of severe anaemia in this

study probably because majority of the subjects were in

WHO clinical stages 1 and 2. However, a study by

fection

. Possible aetiologies of thrombocytopenia in

patients with HIV infection include immune-mediated

15

Adetifa in Lagos, Nigeria , reported severe anaemia of

destruction, thrombotic th_-r₈ombocytopenic purpura,

4

5

.9% in their study. This increase in severity of anaemia

impaired haematopoiesis .

observed in their study could be due to the fact that sig-

nificant numbers of the subjects involved in their study

were those with Centers for Disease Control (CDC)-

defined AIDS (stage C); anaemia severity tends to in-

Even though anaemia in HIV infection could be caused

by a variety of pathophysiologic mechanisms, however,

in tropical areas where malaria infection is endemic, and

other co-morbidities like parasitic infestations, vitamins

and micronutrient deficiencies are important considera-

tions. Therefore, effective treatment and prevention of

these common causes of anaemia should nevertheless

not be overlooked. This can be achieved through health

education, hygiene and sanitation, use of insecticide-

impregnated bed nets, and discouraging children from

walking barefoot outdoors. Parents should be advised to

introduce vitamins and micronutrients rich food to their

infected children.

18-20

crease with advancing HIV disease

.

Higher prevalence of leucopenia (12%) and neutropenia

13%) were observed in HIV-infected children than in

(

controls, while lymphocytopenia was seen in 3.3% of

infected but in none of the controls. Similarly, Angeli

etal noted leucopenia in 32 of 74 (43%) and lymphocy-

topenia in 59 of 74 (78%) in children with advance HIV

2

1

infection in New York. Also another study in US by

Zon and Groopman reported 13% prevalence of neutro-

penia in asymptomatic HIV-seropositive patients and in

75

4% of those with frank CDC-defined AIDS . There-

4

Conflict of Interest: None

Funding: None

fore, decrease of all types of white blood cells can occur

in children with HIV infection, especially in those with

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