Thesis:

Haematological and immunological abnormalities in HIV infected adult patients at Thika level five hospital comprehensive care centre, Kiambu county, Kenya

Human Immunodeficiency Virus (HIV) remains a global issue that causes considerable morbidity and mortality, particularly in sub-Saharan Africa, where greater than 70% of all HIV patients exist. HIV is a multisystem disease and haematological and immunological abnormalities have been reported as among the most frequent complications of HIV infection. CD4+ T cell loss, dysregulation of the cytokine profile and immune system dysfunction are among the immunological changes. Haematological abnormalities involve the three major cell lineages leading to impaired haematopoiesis and cytopenias. This study purpose was to investigate the haematological and immunological abnormalities in HIV infected adult patients at Thika Level Five Hospital CCC, in Kiambu County, Kenya. This cross sectional case control study enrolled 237 subjects who included HIV positive ART- naïve, HIV- positive ART- treated and HIV- negative controls. Sociodemographic information and clinical history data was gathered using a pretested structured questionnaire and from health records. Blood samples were collected and analysed for haematological and immunological (CD4) parameters. Student’s t-tests were employed to compare demographic and laboratory characteristics between groups. Fisher’s exact test was used to determine relationship between immunohaematological abnormalities and ART regimen. A P-value of <0.05 was considered statistically significant. Anaemia, leucopenia and thrombocytopenia were common haematological abnormalities in both ART – treated and ART – naïve HIV infected patients. Overall, leucopenia was the most common haematological abnormality followed by anemia and thrombocytopenia with an overall frequency of 18.9%, 15.2% and 2.5% respectively. The mean ± SD of PLT, ALC, HB, MCV, MCH, PCV, of ART – treated was significantly higher compared with mean ± SD of ART – naïve; 410.80±217.10 vs 309.30±147.90 (p =0.0030), 2.03±0.66 vs 1.50±0.66 (p <0.0001), 13.96± 2.01 vs 12.63±2.99 (p =0.0054), 90.35±10.48 vs 82.92±9.42 (p <0.0001), 27.76±3.18 vs 25.83±3.50 (p =0.0013), 45.53±6.29 vs 40.57±9.13 (p =0.0008) respectively. The mean ± SD CD4 count (378.50±317.7) of ART – treated was higher compared to mean (348.50±256.90) of ART – naïve but not significantly different (p =0.5045). The ART regimen significantly influenced ALC, PCV, MCV, MCH, RDW and CD4 count abnormalities (p- value < 0.05). Patients on TDF/3TC/DTG had significantly higher cases of lymphopenia (P = 0.0252). Macrocytosis was significantly higher in those on AZT/3TC/ATV/r (p- value <0.0001). Low HB (p-value = 0.0021) and low MCH (p-value = 0.0050) were significantly higher in females compared to males. Patient age significantly influenced the PLT abnormality (p-value = 0.003). ART duration significantly influenced WBC abnormality (p-value = 0.0125) and ALC abnormality (p-value <0.0001) of the study subjects. Low CD4 count was associated with thrombocytopenia (p value = 0.0012). Covid -19 vaccine type significantly influenced PLT (p value = 0.0401) and ANC abnormality (p value = 0.0010). HIV infected patients ought to be routinely monitored for haematological and immunological abnormalities followed by appropriate therapeutic interventions so as to improve their quality of life and reduce morbidity and mortality. Haematological parameters can be used as a screening test to assess the severity of HIV infection and response to ART. Optimizing ART regimens to minimize haematological complications is essential for reducing the burden of HIV-related complications.