Journal of
AIDS and HIV Research

  • Abbreviation: J. AIDS HIV Res.
  • Language: English
  • ISSN: 2141-2359
  • DOI: 10.5897/JAHR
  • Start Year: 2009
  • Published Articles: 298

Full Length Research Paper

Assessment of the effect of anti-retroviral therapy on haematological parameters in HIV positive individuals in Zaria

E. M. Kayode
  • E. M. Kayode
  • Institute of Human Virology Nigeria, Jos Plateau State, Nigeria.
  • Google Scholar
D. O. Usiegbodi
  • D. O. Usiegbodi
  • Family Medicine Practice Centre, Gawu-Babangida Niger State Nigeria.
  • Google Scholar
M. E Ajiboye
  • M. E Ajiboye
  • Department of Haematology, Ahmadu Bello University Teaching Hospital (ABUTH) Shika, Zaria, Kaduna State, Nigeria.
  • Google Scholar
I. S.Omonye
  • I. S.Omonye
  • Department of Nursing, Alysia Caring Cambridgeshire United Kingdom.
  • Google Scholar
M. N. Febut
  • M. N. Febut
  • Africa Centre of Excellence in Phytomedicine Research and Development, University of Jos Plateau State, Nigeria.
  • Google Scholar
A. S. Buru
  • A. S. Buru
  • Genomic Research Laboratory, Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Nigeria.
  • Google Scholar


  •  Received: 10 June 2018
  •  Accepted: 25 October 2019
  •  Published: 31 August 2020

 ABSTRACT

A total of 230 patients receiving HAART for the first time and followed regularly were retained and their information gotten using a questionnaire. Of this number, 146 (63.5%) were on Stavudine + Lamivudine + Nevirapine (Regimen 1). 84(36.5%) while the remaining were on zidovudine + Lamivudine + Nevirapine (Regimen 5). The distribution was 75(32.6%) males and 155(67.4%) females. Blood was collected from each patient and analyzed (Baseline) using the Sysmex KX-21N for haematological parameters which include Haemoglobin (Hb), Packed cell volume (PCV), Total White Blood Cell count (WBC), Red blood Cell count (RBC), Platelet count, Neutrophil, Lymphocyte and Mixed count. All the values were repeated after 3 months treatment. The data were analysed using Graph pad InStat version 3. All patients had appreciable increase in CD4 levels, patients on regimen 1 had a significant increase in Hb, PCV and Lymphocyte count with P-value (<0.05). Patients on regimen 5 on the other hand had significant decrease in HB, PCV and Lymphocyte count with P-value (<0.05). In this study, haematological response is better in regimen 1 than regimen 5.

Key words: HIV, highly active antiretroviral therapy (HAART), haematological parameters, anti-retroviral therapy, Zaria.

 


 INTRODUCTION

Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV.  When  several  of such drugs, typically three or four, are taken in combination,  the  approach  is  known  as  highly   active antiretroviral therapy (HAART) (Dybul et al., 2002; Idowu et al., 2013). Standard antiretroviral therapy (ART) consists of the use of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the

progression of HIV disease. Huge reductions have been seen in rates of death and suffering when use is made of a potent antiretroviral regimen (Obiomah et al., 2018; Akos et al., 2018). Hematological abnormalities are frequent among human immunodeficiency virus (HIV)-infected patients and may be directly attributed to the virus or may be caused by opportunistic infections, neoplasms or drugs that cause bone marrow suppression or hemolysis (Swati et al., 2016, Akos et al., 2018; Gebremedhin and Haye 2019), though that can be corrected, prevented and improved by treatment with HAART (Abdulqadir et al., 2018). In a work reported by Taha et al. (2002), levels of haemoglobin, haematocrit, granulocytes, and platelets were significantly lower among antiviral drug-treated groups compared with HIV negative controls (P < 0.0001). These changes were consistent with mild toxicity, and are more noticeable among HIV-infected infants (Ebonyi et al., 2017).

Cytopenia being a common complication of infection with HIV patients, in the course of the disease more than 70% of the patients develop anaemia frequently, requiring blood transfusion (Jacobson et al., 1990; Idowu et al., 2013). Neutropaenia, lymphocytopaenia and thrombocytopaenia are frequently seen indicating that more than one haematopoietic lineage may be impaired. Dysfunction of the bone marrow has been suggested as possible mechanism (Odunukwe et al., 2005; Sathiyavathi and Pugazhendy, 2014). Degree of cytopenia also reflects the severity of the disease. Some antiretroviral drugs have been documented to have cytopenic effect especially when used as monotherapy (Gebremedhin and Haye 2019). Adverse effects of lamivudine in combination with zidovidine cause neutropaenia, anaemia, thrombocytopaenia, and sometimes transient rise in liver enzymes and serum amylase (EMA, 2015). Adverse effects attributed to nevirapin has been reported as eosinophilia, granulopenia, jaundice and increased enzymes, while stavudine has also been reported to cause anaemia, neutropenia and thrombocytopenia (Kofu et al., 1992; Swati et al., 2016; Zerihun et al., 2019). The aim of this work therefore, is to find out the extent of the effect of HAART  on  haematological  parameters  in  HIV positive patients in Zaria metropolis. This will also help to ascertain and recommend the particular drug combination that is suitable for HAART. And this can also help to ascertain if haematological response can be used as a tool for monitoring patients on treatment in areas where CD4 count is not available or cannot be done.

 


 MATERIALS AND METHODS

Data source

Written informed consent was obtained from patients in the hospital before issuing the questionnaire. Data were collected through using the structured and pre-tested questionnaire.

Methods

Questionnaire containing detailed information about the patient was issued and only individuals who adhere strictly to their therapy residing within Zaria metropolis were used for this study. The baseline sample was collected for analysis and the patient continued therapy for another 3 months when another sample was collected for analysis. A total of 230 patients were enrolled in this work and 49 healthy individuals not on HAART were used as control. All pregnant women patients on admission and those residing outside Zaria metropolis were excluded from this work. For the purpose of this work an automated haematology counter was used, (Sysmex KX-21N) and baseline haematological indices such as Haemoglobin, white blood cell (WBC) count and WBC differential count were obtained. 4 millilitres (4mls) of blood was collected from the antecubital fossa of each individual enrolled in the program using EDTA anticoagulant vacutainer. Reagent such as: Cellpack WBC/Hb lyse reagent: Stromatolyser-WH were used and standard operating procedure was observed according to manufacturer’s instruction.

Statistical analysis

The data statistical analysis was performed using the information entered into SPSS version 20.0 software. While P < 0.05 was considered statistically significant.

 


 RESULTS

In the study, a total of 230 adults on HAART consented to participate in this study giving a response rate of 100% as shown in Table 1. Out of the 230 that participated,  the age group 21-30 recorded the highest number of participants 100 (43.5%), followed by age group 31-40 with 64 (27.8%) participants, with the least being age group 0-10 with 7 (3.0%). The mean age of the participant was 25.5 years. Seventy five (32.6%) participants were male, while one hundred and fifty five (67.4%) were females. In the male age group, ages 31-40 has the highest number of participants 26 (40.6%), with the least ages 0-10 with 2 (28.6%). The female participants ages 21-30, 85 (85%) has the highest number of patient participation, with the least age 0-10 5(71.4%) as compare with the male participants as shown in Table 2. The sex distribution as indicated by the participant in relation to age is shown in Figure 1. With the age 21-30 having the highest number of female participants, while age 31-40 recorded  the  highest  male participant, with age 0-10 having the least number of both female and male participants. The two hundred and thirty HAART patient that participated in this study, 146 (63.5%) were on Stavudine+Lamivudine+Nevirapine (Regimen 1), while the remaining participants 84 (36.5%) were on Zidovudine+Lamivudine+Nevirapine (Regimen 5) as shown in Table 3. The baseline comparison of the haematological parameters of patients on regimen 1 after 3 months showed a marked increase in Hb, Packed cell volume (PCV) and lymphocytes counts with P-value (<0.05) as shown in Table 4 and Figure 2, while that of regimen 5 is as shown in Table 5 and Figure 3. Comparing the haematological parameters in relation to their response after 3 months, indicated that participants on regimen 1 showed a better response to treatment than participant  in  regimen  5  as  shown in Table 6, with their P-value (<0.05) showing a significant decrease in HB, PCV and lymphocytes counts in Tables 7 and 8 respectively.

 

 

 

 

 

 

 

 

 

 

 

 


 DISCUSSION

Haematological abnormalities is often associated as a value (<0.05) showing a significant decrease in HB, PCV and  lymphocytes  counts  in Tables 7 and 8 respectively. health challenge with HIV infected individuals, the assessment of such is vital to the general response of the infected individual to anti-retroviral therapy. Anti-retroviral drugs (ARD) are known to be toxic to liver and bone marrow, in several studies the relationship of HIV viruses and anti-retroviral drug effect on haematological parameters has been reported (Kwame et al., 2018; Zerihun et al., 2019). The study observed an overall effect of HAART in relation to haematological parameters in   patients   attending   (HAART)   Clinic   in   Zaria.  The percentage difference of about 57.5% was seen in the first group placed on drugs in regimen 1 which includes Stavudine + Lamivudine + Nevirapine, compare with those in group two placed on regimen 5 which contains Zidovudine   +   Lamivudine   +   Nevirapine.  Patients  on regimen 1(non-zidovudine containing HAART) had an appreciable significant increase in haemoglobin (Hb) and packed cell volume (PCV) value both having P-values of 0.0001 as shown in Tables 4, 6 and 7. This is in line with the works of Odunukwe et al. (2005); Ebonyi et al. (2017) who noted an increase in haemoglobin and PCV in 50 patients placed on regimen 1. It also agrees with the works of Osaro et al., (2009). Abdulqadir et al. (2018) and Gumel et al., 2019) who noted a significant increase in haemoglobin from baseline values. There was also a statistically significant decrease in WBC with P-value 0.0001.This agrees with Umar et al. (2007) who established a decrease in leucocyte count upon administration of regimen 1. However this is in contrast with the work of Ejele et al. (2004) who noted that there was no significant change in leucocyte level. Lymphocyte also had a statistically significant increase with P-value of 0.0421 which also agrees with the work of Odunukwe et al. (2005), Osaro et al. (2009), Enawgaw et al. (2014) and Ako et al. (2018) on statistically significant increase in lymphocyte count. Other parameters such as Red Blood Cell, Neutrophil and Platelets were not statistically significant. On regimen 5 (zidovudine containing HAART), statistically significant decrease were noted in haemoglobin, PCV, lymphocyte count and a significant increase in neutrophil count as shown in Tables 5, 6 and 8. This is in line with the work reported by Aurpibul et al. (2008) on decrease in haemoglobin level following the substitution of stavudine with zidovudine. It also agrees with the work of Nacoulma et al. (2007) and Gebremedhin and Haye (2019). On anaemia in patients on zidovudine containing HAART but is in contrast with this work on the increase in neutrophil count. It is also in line with the work of Taha et al. (2002), who reported a significant decrease in haemoglobin and lymphocyte value, and that of Balakrishnan et al. (2010) and Ifeanyichukwu and Bright (2016) who reported anaemia due to zidovudine-induced pure red cell aplasia. However, other parameters such as Red Blood Cell, Platelet and White Blood Cell were not statistically significant. This is in contrast with the report of Aurpibul et al. (2008) and Sheela et al. (2016) on a significant decrease in White Blood Cell count on substitution of stavudine with zidovudine.

 


 CONCLUSION

As a result of this work, it is concluded that regimen 1 (stavudine + lamivudine + nevirapin)  combination  results in improved haematological values of HIV patients especially values like Haemoglobin and PCV. While regimen 5 (zidovudine containing HAART) could be responsible for most cases of anaemia and leucopenia in HIV patients.

 


 RECOMMENDATIONS

(i) Since the haematological effects could be noticed within the three months of study, it therefore indicates that haematological response could be used for patients monitoring in settings where CD4 count cannot be done.

(ii) Haematological parameters should be made mandatory for patients on HAART as a way of checking other complications that may arise due to drug administration.

(iii) Also regimen 1(stavudine + lamivudine + nevirapin) should be used in preference to regimen 5 (zidovudine containing HAART) as this will reduce the adverse effects on haematological parameters.

 


 CONFLICT OF INTERESTS

The authors have not declared any conflict of interests.

 



 REFERENCES

Abdulqadir I, Ahmed SG, Kuliya AG, Tukur J, Yusuf AA, Musa AU (2018). Hematological parameters of human immunodeficiency virus positive pregnant women on antiretroviral therapy in Aminu Kano Teaching Hospital Kano, North Western Nigeria. Journal of Laboratory Physicians 10:60-63.
Crossref

 

Ako SE, Njunda LA, Akum EA, Benjamin PT, Assob JC, Enoh JE, Bernard W, Fabrice NG (2018). Immuno-hematological Profile Trends of HIV/AIDs Patients on HAART in the South West Region of Cameroon: Retrospective Medical Report Review for Possible Stratified follow-up Pattern in Low Income Settings. American Journal of Microbiological Research 6(2):47-56.
Crossref

 

Aurpibul L, Puthanakit T, Sirisanthana T, Sirisanthana V (2008). Haematological changes after switching from stavudine to zidovudine in HIV-infected children receiving highly active antiretroviral therapy. HIV Medicine 9(5):317-321.
Crossref

 

Balakrishnan A, Valsalan R, Sheshadri S, Pandit VR, Medep V, Agrawal RK (2010). Zidovudine-induced reversible pure red cell aplasia. Indian Journal of Pharmacology 42:189-191.
Crossref

 

Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK, Panel on Clinical Practices for Treatment of HIV (2002). "Guidelines for using antiretroviral agents among HIV-infected adults and adolescents" Annals of Internal Medicine.137:381-433.
Crossref

 

Ebonyi AO, Oguche S, Ochoga MO, Agbaji OO, Anejo-Okopi JA, Abah IO, Okonkwo PI, Idoko JA (2017). Changes in the haematological parameters of HIV-1 infected children at 6 and 12 months of antiretroviral therapy in a large clinic cohort, North-Central Nigeria. Journal of Virus Eradication 3(4):208-211.
Crossref

 

Ejele OA, Erhabor CA, Nwauche A (2004). Haematologic effects of some antiretroviral drugs in patients with AIDS. Sahel Medical Journal 8:25-29.
Crossref

 

EMA (2015). Lamivudine/Zidovudine, Teva, INN-lamivudine/zidovudine.

View

 

Enawgaw B, Alem M, Addis Z, Melku M (2014). Determination of hematological and immunological parameters among HIV positive patients taking highly active antiretroviral treatment and treatment naive in the antiretroviral therapy clinic of Gondar University Hospital, Gondar, Northwest Ethiopia: a comparative cross-sectional study. BMC Hematology 14:8.
Crossref

 

Gebremedhin KB, Haye TB (2019). Factors Associated with Anemia among People Living with HIV/AIDS Taking ART in Ethiopia Advances in Hematology 2019.
Crossref

 

Gumel SD, Ibrahim A, Olayinka AT, Ibrahim MS, Balogun MS, Dahiru A, Ajayi I, Ajumobi O, Ahmadu I, Song A, Maifada AI, Abdullahi H (2019). HIV-malaria co-infection and its determinants among patients attending antiretroviral treatment clinic in Zaria, North-Western Nigeria. BioRxiv 588855
Crossref

 

Idowu CO, Oke OT, Afolayan DO, Olaniran O, Akinloye OA, Awodumila OO (2013). Effect of HAART on some haematological parameters, correlations between total lymphocyte and CD4 counts of HIV clients attending ssh, Ikole-Ekiti. International Journal of Biological and Medical Research 4(3):3265-3270.

 

Ifeanyichukwu OM, Bright EO (2016). Effect of HIV infection on some haematological parameters and immunoglobulin levels in HIV patients in Benin City, Southern Nigeria Journal of HIV and Retro Virus 2:2.
Crossref

 

Jacobson MA, Periperl L, Volberding PA, Porteous D, Toy PT, Feigal D (1990). Red Cell Transfusion Therapy for anaemia in patients with AIDS and ARC: incidence associated factors and outcome Transfusion 30:133.
Crossref

 

Kofu K, Gresham-Dame GM, Peters M (1992). Rapid spread of HIV infection in Abidjan, Ivory Coast. European Journal of Clinical Microbiology and Infectious Diseases 11(27):1-3.
Crossref

 

Kwame WO, Edzeamey FJ, Dompreh A, Gborgblorvor D, Awuah M, Ako AK, Asamoah GD (2018). Correlation of Hematological Parameters with TNF-α and Interleukin (IL-6) in Seropositive HIV Patients on Highly Active Antiretroviral Therapy (HAART) and HAART Naïve Patients. International Journal of Research and Reports in Hematology 1(1):1-7

 

Nacoulma EW, Some Y, Tieno H, Diallo I, Zoungrana A, Bougnounou R, Ouédraogo C, Drabo J, Guiard-Schmid JB (2007). Haematological parameters evolution during the antiretroviral therapy of HIV infected patients in Burkina-Faso]. Bulletin de la Societe de pathologie exotique 100(4):271-274.

 

Obiomah CF, Obeagu EI, Ochei KC, Swem CA, Amachukwu BO (2018). Haematological Indices of HIV Seropositive Subjects at Nnamdi Azikiwe University Teaching Hospital (Nauth), Nnewi. Annals of Clinical and Laboratory Research 6(1):221.

 

Odunukwe N, Idigbe O, Kanki P, Adewole T, Onwujekwe D, Audu R, Onyewuche J (2005). Haematological and biological response to HIV-1 infection with combination of nevirapine + stavudine + lamivudine in Lagos Nigeria. Turkish Journal of Haematology 22(3):125-131.

 

Osaro E, Emmanuel KU, Osekhuiemen AE, Confidence W (2009). Effect of long-term highly active antiretroviral therapy (HAART) on some haematological parameters of HIV-infected Nigerians. Heama 9(1):107-113. 

 

Sathiyavathi S, Pugazhendy K (2014). Assessments of haematological parameters in hiv patients present in and around salem district tamilnadu, India. International Journal of Modern Research and Reviews 2(11):501-504.

 

Scadden DT, Zeira M, Woon A, Wang Z, Schieve L, Ikeuchi K, Lim B, Groopman JE (1990). Human immunodeficiency virus infection of human bone marrow fibroblast. Blood 76:317.
Crossref

 

Sheela Devi CS, Suchitha S, Gupta M (2016). A study of hematological profile in human immune deficiency virus infection: Correlation with CD4 counts. Annals of Pathology and Laboratory Medicine 3:484-489.

 

Swati K, Permeet Kaur B, Sita M (2016). Hematological manifestations in HIV infected patients and correlation with CD4 Counts and anti-retroviral therapy. International Journal of Contemporary Medical Research 3(12):3495-3498.

 

Taha TE, Kumwenda N, Gibbons A, Hoover D, Lema V, Fiscus S, Broadhead R (2002). Effect of HIV-1 antiretroviral prophylaxis on hepatic and hematological parameters of African infants. AIDS 16(6):851-858.
Crossref

 

Umar RA, Ladan MJ, Hassan SW, Sa'id Y, Abbas AY, Oduolisaeme IB (2007). Administration of antiretroviral drugs (Lamivudine, Nevirapine and Stavudine) has no untoward effect on haematological profile in albino rats. Asian Journal of Biochemistry 2:147-151.
Crossref

 

Zerihun KW, Bikis GA, Muhammad EA (2019). Prevalence and associated factors of anemia among adult human immune deficiency virus positive patients on anti-retroviral therapy at Debre Tabor Hospital, Northwest Ethiopia. BMC Research Notes 12(1):168.
Crossref

 




          */?>