Highly Active ART Treatment Improved Immunohematological Profile

Immunohematological parameters were found to significantly improve after patients with HIV started highly active antiretroviral therapy (HAART), according to a study published in the Journal of Blood Medicine. The effects of HAART were most effective when taken for at least 6 months.

The depletion of the immune system is a main characterization of HIV. HIV patients have immunohematological abnormalities that could be caused by a number of reasons, with the most common hematological disorder being anemia. Evaluating treatment and prognosis for patients with HIV necessitates understanding immunohematological outcomes. This study aimed to expand the literature on how HAART improves immunohematological changes in patients with HIV who live in Ethiopia.

3d illustration of HIV virus | Image credit: artegorov3@gmail - stock.adobe.com

The study took place from February to July 2021 at Yabelo General Hospital in Borana, Ethiopia, which provides ART services for patients with HIV. A standardized questionnaire was given to study participants to collect clinical data. Patients who had HIV and were taking HAART for at least 6 months were included in the studies. Patients were excluded if they were taking vitamins or iron supplements, were pregnant, or had received a blood transfusion within the previous 4 months.

Complete blood count, CD4, and clinical and demographic data were collected from the participants prior to the start of HAART treatment. A trained data collector collected data in study participants after at least 6 months. All patients had their blood collected once in the morning.

There were 333 patients who were aged 18 years and older included in this study. A total of 51.1% were male and a mean (SD) age of 32.83 (9.48) years. More than half of the participants were urban residents (58.6%), 45.3% were married, 33.6% had no formal education, and 25.5% were housewives.

Most of the participants (45.3%) were in World Health Organization (WHO) clinical stage I before starting HAART, with the rest being in stage 2 (28.5%), 3 (18.3%), and 4 (7.8%). A total of 99.1% of the participants were able to achieve clinical stage 1 after at least 6 months of treatment with HAART, and the remaining patients were in stage 2. The mean body mass index (BMI) of the participants increased from 20.14 to 22.19 from before and after HAART.

White blood cell count increased from a mean of 4.106 (0.970) to 4.995 (1.34) and hemoglobin B concentration increased from 12.38 (1.77) to 13.22 (1.81). Mean corpuscular value increased from 87.57 (11.63) to 89.99 (8.87) and platelets changed from 243.3 (52.59) to 292.18 (60.539). Lastly CD4 had a mean change of 227.14 cells/mL.

A total of 47.4% of patients were anemic at baseline, which decreased to 23.1% after 6 months of HAART treatment. Although the prevalence of anemia went down, the severity of anemia remained almost the same with mild going from 89.9% to 92.2%, moderate going from 6.3% to 2.6%, and severe going from 3.8% to 5.2%.

There were 207 (62.2%) patients that had immune suppression of a CD4 count less than 350 cells/mL at the start of treatment. Immune suppression was reduced to 20.7% of the patients and severe immunodeficiency was reduced from 45.9% to 20.7%. The majority of patients had CD4 greater than 500 cells/mL after 6 months of HAART treatment.

The researchers found that sex and treatment interruption were the variables most associated with current anemia. Patients with a BMI of 18.49 or less were more likely to develop anemia (odds ratio [OR], 5.428; 95% CI, 1.425-20.674) compared with patients with normal BMI. Female patients were more likely to have anemia compared with male patients (OR, 2.02; 95% CI, 1.164-3.503) and patients with treatment interruption were more likely to be anemic compared with those that did not (OR, 1.835; 95% CI, 1.003-3.359).

The researchers concluded that various immuhematological parameters, including anemia, thrombocytopenia, and CD4+T lymphocytopenia, improved dramatically when patients took HAART for at least 6 months. HIV testing should be promoted so that patients can receive HAART as soon as possible.

Reference

Ashenafi G, Tibebu M, Tilahun D, Tsegaye A. Immunohematological outcome among adult HIV patients taking highly active antiretroviral therapy for at least six months in Yabelo Hospital, Borana, Ethiopia. J Blood Med. 2023;14:543-554. doi:10.2147/JBM.S419414