Anemia, leucopenia especially neutropenia and thrombocytopenia were common findings in the present study. This was also documented in different studies [1, 2, 4]. Prevalence of pancytopenia (0.7%) was lower than study done in India 6% in 2008 [3]. Also Prevalence of anemia in this study (20.7%) was lower than study done in India in 2002 [7] and 2008 [3] which was 30.8% and 65.5% respectively, Southern India 41% [13], Brazil 37.5% [14], Nigeria from 2000–2005 (74%) [15], Nigeria between June 2002 and July 2003 (80%) [16]. This may be due to the difference in study population, socio-demographic characteristics of study subjects and study design methods.
In this study prevalence of anemia in HAART naïve patients was 29.7% and on those patients on HAART was 11.7%. This indicates that prevalence of anemia is higher in treatment naïve patients (P < 0.001). This is consistent with study done in Ghana [17] and US [18]. The findings of this study affirm that hematological disorders are corrected by combination antiretroviral therapy which also decreases the viral load. Thus HIV patients who were on HAART had greater numbers of blood cells within six months of beginning treatment and hematological disorders were corrected [19].
In this study normocytic normochromic anemia was the dominant type (43.3%) of anemia. This is supported by different studies in which normocytic-normochromic anemia is the commonest type of anemia in HIV patients [3–5, 7, 8]. Findings in New Delhi (66.5%) [7] in 2002 and in Nigerians (64%) between June, 2002 to July, 2003 [16] showed normocytic- normochromic anemia which supports this study findings.
In this study majority of HAART naïve patients (48.9%) have normocytic-normochromic anemia while about 58.8% patients developed macrocytic-normochromic anemia (p < 0.001). This is probably due to the effect of HAART which is responsible for the development of macrocytosis.
The prevalence of anemia was significantly higher (34.5%, P = 0.011) in patients with CD4 count < 200/μl. This is consistent with different studies such as in a study in Southern India [13] 64% and Brazil 61.1% [14] with CD4 count < 200/μl. Patients with CD4 count <200/μl may have low immunity. This may be caused by direct and indirect effect of HIV infection (viral load), opportunistic infections, and toxicity of the drugs [3, 20].
Leucopenia prevalence in this study was 26.6% which was higher than the prevalence in studies done in Nigeria from 2000–2005 [15] and from 2002 – 2003 [16] which showed prevalence of 5.88%, 16.1% and 10% respectively. Another study at the HIV clinic of Lagos [4] showed similar findings in leucopenia (26.8%). In the present study, prevalence of neutropenia and lymphopenia was 21.4% and 2.1% respectively, which is lower than is reported in a study done in Nigeria between 1995 and 2000 in which 64.4% and 40% presented with lymphopenia and neutropenia respectively [21]. This difference may be due to variation in study populations, clinical conditions and study design methods.
Patients on HAART showed statistically significant increase in leucopenia and neutropenia compared to their HAART-naïve counterparts (p < 0.01). Similarly when patient’s CD4 count decreases prevalence of leucopenia and lymphopenia increases (p < 0.05). This may be due to suppression of bone marrow and direct infection of T cells. Having CD4 count <200 was higher in HAART naïve patients (26.9%, P = 0.013) than those on HAART (13.1%). This condition reduces the body’s resistance to many opportunistic infections and the patient becomes more susceptible to bacterial infections and needs medical attention, the condition may become life-threatening.
On the other hand prevalence of thrombocytopenia (6.6%) in this study was lower than reports from a study done in Lagos (16%) [4] and Nigeria between 2002 and 2003 (10%) [16]. This possible cause of thrombocytopenia may be due to immune destruction of platelets. It is known that many chronic human diseases may have an underlying autoimmune mechanism [22].
There was no significant difference in the prevalence of thrombocytopenia between study participants on HAART and those who are HAART-naïve. Thrombocytopenia, however, increases as CD4 decreases (p = 0.007). Thrombocytopenia probably increases as immunological incompetence worsens thus leading to increased risk of excessive bleeding [9, 10].
This study does not address iron status of study participants hemoglobinopathies, inherited membrane disorders and other nutritional deficiencies because of lack of resources. Also the study focused only on comparisons of hematological and immunological parameters but does not addresses risk factors.