Prevalence of anaemia in HIV-infected children at the University of Abuja Teaching Hospital, Gwagwalada.
BACKGROUND
Use of highly active antiretroviral therapy (HAART) has remained the only regimen potent enough to reduce viral replication in HIV-infected individuals. Its combination with cotrimoxazole has also been recommended in those with CD4% of less than 15%. The use of HAART containing zidovudine (ZDV) in combination with co-trimoxazole carries the risk of anaemia in already anaemic predisposed individuals from HIV infections, opportunistic infections, parasitic infestations, sickle cell anaemia, and malnutrition. The aim of the study is to document the effect of use of combination of HAART containing ZDV with cotrimoxazole in haemoglobin profile of HIV-infected children after one year of its administration at the University of Abuja Teaching Hospital (UATH), Gwagwalada. It is also aimed at comparing the result obtained with those on stavudine containing HAART with co-trimoxazole.


METHODS
A two year prospective study of HIV-infected children on treatment with HAART in combination with co-trimoxazole, and attending the paediatric outpatient special treatment clinic (POSTC) for HIV infected children at the UATH, Gwagwalada from November 2006 to October 2008, was carried out to determine effect of these drug combinations in the haemoglobin profile of infected children. Three monthly PCV level was carried out using haematocrit centrifuge and reader.


RESULTS
A total of 173 patients were started on HAART during the first year recruitment period, 90 (52.0%) were males, while 83 (48.0%) females, giving a male to female ratio of 1.1:1. One hundred and seventeen (67.7%) of patients were on ZDV containing HAART, while 56 (32.3%) were on stavudine containing combination. All patients were started on co-trimoxazole prophylaxis with the exception of 6 (3.5%) patients because of drug reaction. The mean PCV of patients on ZDV containing combination with cotrimoxazole decreased from 30.2 +/- 5.5% to 29.0 +/- 2.3%, with a net decrease of 1.2% after one year treatment, those on stavudine containing combination with co-trimoxazole instead showed an increased from initial PCVof 28.3 +/- 4.2% to 34.2 +/- 3.0% with a net increase of 5.9% after the same duration of treatment, (p > 0.05). While patients on ZDV combination alone without co-trimoxazole prophylaxis had a minimal decrease of 0.9% in their PCV level after one year treatment, those on stavudine combination alone without any prophylaxis instead showed an increase of 6.8% in their PCV after the same duration of treatment.


CONCLUSIONS
A combination of HAART containing ZDV plus co-trimoxazole carries risk of anaemia than that of stavudine containing combination with co-trimoxazole. Such combination should therefore not be given to anaemic patients. Regular check in PCV of patients on HAART combination with ZDV and additional cotrimoxazole prophylaxis is required for early detection of significant drop in PCV level.
Okechukwu
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AA
Department Of Paediatrics, University Of Abuja Teaching Hospital, Gwagwalada.
Gambo
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D
Okechukwu
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IO
D000293:Adolescent; D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology; D000890:Anti-Infective Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D006400:Hematocrit; D006403:Hematologic Tests; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D018119:Stavudine / Q000009:adverse effects*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*; D015215:Zidovudine / Q000009:adverse effects*
D000890:Anti-Infective Agents; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D018119:Stavudine