Evaluation of Full Haemogram and CD4 Counts in HIV Infected Patients and Comparison of their Use in Monitoring Antiretroviral Regimen

M’rama, Jackson Ireri (2009) Evaluation of Full Haemogram and CD4 Counts in HIV Infected Patients and Comparison of their Use in Monitoring Antiretroviral Regimen. Masters thesis, Kenyatta University.

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Abstract

There is currently no cure for Human Immunodeficiency Virus (HIV) infection but the introduction of highly active antiretroviral therapy (HAART) has led to a significant reduction in AIDS related morbidity and mortality. For effective antiretroviral therapy (ART) an ideal level of laboratory investigation before and during therapy is recommended. The cost of assessing CD4 + cell counts; one of the recommended tests is beyond the reach of the majority who inhabit the sub-Saharan African countries. In this study the possibility of using full haemogram, a simple and cheap test in monitoring ART in place of CD4+ cell counts in resource-limited settings was determined. A total of 200 HIV-infected adults at different clinical stages of HIV/AIDS attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital and 20 HIV sero-negative (referents) adults were recruited in the study. Of the HIV-infected subjects 103 were ARV-naive and 97 were on different combinations of ARV-triple therapy. The levels of CD4+ cells, CD3+ cells, and CD8+ cells in the subjects were analysed by FACS instrument; haematological parameters were analysed by a cell-dyne 1300 model cell counter while differentials of white blood cells and the blood cell morphology were done on stained thin peripheral blood films (PBF's). Wintrobe tube apparatus was used to measure erythrocyte sedimentation rate (ESR). Neutrophil hypersegmentation, presence of target cells and rouleaux formations were occasionally noted in the PBFs of the HIVinfected subjects. Progressively severe anaemia was observed as the disease advanced. Following ART anaemia significantly reduced and red blood cells (RBCs) with high mean cell volume (MCV) were observed. Higher CD4+ cell, neutrophil and platelet counts in referent females than the males were observed. Accelerated ESR was noted among the infected subjects. Peaks of neutropenia at the initial and final stages of HIV were noted. The levels of CD4+ cells counts decreased as the disease progressed but total lymphocyte count (TLC) showed insignificant decrease and were also not significantly corrected by ARVs. Consistent correlations between the lymphocyte subsets and each of RBC, WBC, haemoglobin (HB), and MCV were observed. In conclusion the results indicated that HIV-infection interferes with the development of RBCs and ART enlarged their sizes (MCV), the severity of anaemia is associated with the disease advancement and there are gender-based differences in immunohaematological parameters. It is difficult to use immunohaematological parameters to stage HIV. The CD4+ cell count is the best markers for HIV disease progression and that TLC alone cannot be used to replace CD4+ cells but inclusion of WBCs, RBCs, HB and MCV can increase the sensitivity and specificity of TLC in predicting changes in CD4+ cells in resource-limited settings.

Item Type:	Thesis (Masters)
Subjects:	Q Science > QD Chemistry R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RB Pathology
Divisions:	Africana
Depositing User:	Tim Khabala
Date Deposited:	12 Sep 2017 12:09
Last Modified:	12 Sep 2017 12:09
URI:	http://thesisbank.jhia.ac.ke/id/eprint/2185

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