Prevalence and correlates of cytopenias in HIV-infected adults initiating highly active antiretroviral therapy in Uganda

Background: Cytopenias are the most common HIV-associated hematological abnormality. Cytopenias have been associated with several factors including sex, race/ethnicity, geographical location and comorbidities such as tuberculosis, hepatitis B infection, fever and oral candidiasis. Cytopenias become more prevalent as HIV progresses and are often fatal. Data from resource-limited settings about the prevalence and correlates of cytopenia are limited. Therefore we conducted this cross-sectional study to assess the prevalence and correlates of cytopenia among adult AIDS patients at initiation of HAART in Uganda. Methods: 400 HIV-infected subjects who were HAART-naive or on HAART for <= 6 months were enrolled into the Multivitamins, HAART and HIV/AIDS Trial. Anemia was defined according to WHO guidelines as any hemoglobin concentration < 12 g/dl for non-pregnant females and < 13 g/dl for males. Leucopenia and thrombocytopenia were defined using study site laboratory reference ranges for lack of generally accepted definitions for these 2 cell lines as leucopenia if white blood cell count < 2.75 x 10(9) cells/litre and thrombocytopenia if platelets < 125 x 10(9) cells/litre for females and < 156 x 10(9) cells/litre for males. Univariate and bivariate analyses were done to describe the patient population and log-binomial regression was used to quantify the correlates of cytopenia. Results: Sixty five percent of the 400 subjects had at least one form of cytopenia. Anemia occurred in 47.8%, leucopenia in 24.3%, thrombocytopenia in 8.3%, bicytopenia in 21.9% and only 2 had a pancytopenia. Cytopenia was more prevalent in females ( prevalence ratio [PR]: 1.33, 95% confidence interval [CI]: 1.12-1.59); CD4 count category 50 to < 200 ( PR: 0.75, 95% CI: 0.64-0.88) and CD4 count category 200 to < 350 ( PR: 0.74, 95% CI: 0.59-0.92) compared to CD4 count category < 50; normal BMI ( PR: 0.82, 95% CI: 0.68-1.00) and overweight BMI ( PR: 0.64, 95% CI: 0.50-0.82) compared to underweight BMI and those with a history or presence of oral candidiasis. Conclusions: Cytopenias are a frequent complication in HIV-infected adults at initiation of HAART in Uganda. The presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index. Prospective studies in resource-limited settings on the trend in HIV-related cytopenias are needed.