A description of full blood count abnormalities in HIV-infected children less than three years of age before and after combined antiretroviral therapy initiation

Abstract

Background: Early cART reduces mortality and morbidity in HIV-infected children. Cytopaenias may develop in HIV-infected individuals, contributing to poor outcomes and few descriptions of cytopenias are available in children. Objectives: Describe the prevalence and outcomes of cytopaenias at baseline (cART initiation) and 6 and 12 months in HIV-infected children at Chris Hani Baragwanath Academic Hospital. Methods: Electronic and paper-based records of HIV-infected children under 3 years of age and initiating cART between the 1st January 2010 and 31st December 2012 were reviewed. Anthropometric measurements, clinical characteristics and laboratory findings at baseline, 6 and 12 months of cART were collected for analysis and compared at each outcome. Results: At baseline, the 185 HIV-infected children eligible for this study had a median age of 13 months (range 1 – 36), with advanced disease: 44% were underweight and stunted, 31% were wasted; 92% had WHO stage III/IV, CD4 count <15% in 36% and 85.5 % had a viral load ≥100 000 copies/ml. The median haemoglobin was 9.9 g/dl, white cell count 11.8 x 109/L and platelet count 354 x 109. Anaemia, thrombocytopaenia and leukopaenia were present in 80%, 6.9% and 1.2% of children respectively. At 6 months the proportion of children with anaemia decreased to 46% (p<0.001) and 32% (p<0.001) at 12 months after cART; and thrombocytopaenia decreased to 1.9% (p<0.320) and 0.86% (p=0.017). Conclusions: The majority of HIV-infected patients are anaemic at baseline. This study shows that at 6 and 12 months, there is significant reduction in anaemia and thrombocytopaenia, likely related to cART.