Prevalence and Underlying Factors of Anemia Among Adult HIV Patients Undergoing Highly Active Antiretroviral Therapy at Murang’a Level 5 Hospital, Kenya

Abstract

Background: Anemia is a disorder whereby the body has inadequate healthy erythrocytes. Erythrocytes' function is to carry oxygen throughout the body. Anemia affects over 2billion people worldwide. In Human Immunodeficiency Virus (HIV) infected patients, the highest anemia prevalence in Africa was in Congo at 63%,  in Ethiopia, it was as low as 26.2%. In Kenya, among adult pregnant women not initiated on antiretroviral therapy, anemia was  at 65.2% while negative control group was 19.6%. In Murang’a County Kenya, there was paucity of data on anemia in HIV patients.  

Methods: A cross-sectional study was implemented, 295 study participants were enrolled. Demographic and clinical data were obtained using structured questionnaires. Body mass Index (BMI) calculated. 4ml of blood was collected into an anticoagulant vacutainer for analysis of hematological indices. Baseline CD4, defaulter history, antiviral regimen, prophylaxis and current World Health Organization (WHO) HIV staging were obtained from the Kenya Electronic Medical Record (EMR). Current CD4 value determined using BD FACS PRESTO. Complete blood count (CBC) done using Medonic hemolyzer.

Results: prevalence of anemia was 42.03%. Among n=124 anemic participants mild, moderate and severe anemia was 50.8%, 27.9% and 21.3% respectively. Prevalence related with: year of diagnosis(P-value 0.001) , age( P value 0.012),HIV staging(P-value 0.001), viral load (P value 0.03,BMI(P value=0.002),Defaulter history (P value 0.001)and hematological indices . At CV=0.174: Low HB correlation with HCT was (0.81), MCV (P-value 0.49), MCH (0.40), MCHC (-0.36) and WBC (-0.53), PLT (-0.09) and VL (-0.40). P value=0.008. No linear relation between the CD4 count and HB levels.

Conclusion: There is need for regular monitoring of HB and other related hematological parameters in HIV patients. Collaboration of healthcare workers including hematologists and nutritionists would ensure a more holistic approach in HIV management. Trends like year of diagnosis should be understood and involved in anemia management. Continuous research to determine the complex correlation between anemia and opportunistic infections is necessary