title: Neutropenia in human immunodeficiency virus infection: data from the women's interagency HIV study.
abstract: BACKGROUND
  Neutropenia is well described in individuals infected with human immunodeficiency virus (HIV) and occurs in approximately 10% to 50% of cases. Neither the effect of highly active antiretroviral therapy (HAART) on neutrophil counts nor the significance of neutropenia in terms of survival has previously been evaluated.
  
  
  METHODS
  The prevalence of neutropenia among 1729 HIV-infected women, followed up as part of the Women's Interagency HIV Study, was evaluated. The CD4 lymphocyte counts, HIV-1 RNA levels, and complete blood cell counts, including absolute neutrophil counts, were obtained at 6-month intervals.
  
  
  RESULTS
  Neutropenia was common among HIV-infected women; at baseline, 44% had neutrophil counts less than 2000/microL, whereas 7% had counts less than 1000/microL. During 7.5 years of follow-up, neutrophil counts less than 2000/microL occurred on at least 1 occasion in 79%, whereas absolute neutrophil counts less than 1000/microL were documented in 31%. Worsening HIV disease parameters, such as lower CD4 cell counts (P<.001) and higher HIV-1 RNA levels (P<.001), were associated with development of neutropenia. Resolution of neutropenia was associated with higher CD4 cell counts (P<.001) and use of HAART (P=.007). We found that HAART, without zidovudine, was associated with protection against development of neutropenia. On multivariate analysis, neutropenia was not found to be associated with decreased survival among HIV-infected women.
  
  
  CONCLUSIONS
  Worsening HIV disease parameters are associated with neutropenia in HIV-infected women. Treatment with HAART, without zidovudine in the regimen, protects against development of neutropenia, whereas HAART use and higher CD4 cell counts are associated with resolution of neutropenia. Neutropenia is not associated with decreased survival in HIV-infected women.
authors.affiliation: Department of Medicine, Division of Hematology, University of Southern California, Los Angeles, CA 90033, USA. alevine@usc.edu
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Roksana
authors.initials: R
authors.lastname: Karim
authors.forename: Wendy
authors.initials: W
authors.lastname: Mack
authors.forename: D Jay
authors.initials: DJ
authors.lastname: Gravink
authors.forename: Katherine
authors.initials: K
authors.lastname: Anastos
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: Mardge
authors.initials: M
authors.lastname: Cohen
authors.forename: Meg
authors.initials: M
authors.lastname: Newman
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Stephen
authors.initials: S
authors.lastname: Gange
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index