Impact of highly active antiretroviral therapy on hematological indices among HIV-1 infected children at Kenyatta National Hospital-Kenya: retrospective study.
BACKGROUND
HIV infected children experience a range of hematological complications which show marked improvement within 6 months of initiating anti-retroviral therapy. The Objectives of the study was to describe the changes in hematological indices of HIV-1 infected children following 6 months of treatment with first line antiretroviral drugs (ARVs) regimen.


METHODS
A retrospective study was conducted between September and November 2008. During this period medical records of children attending Comprehensive Care Clinic at Kenyatta National hospital were reviewed daily. HIV infected children aged 5-144 months were enrolled if they had received antiretroviral drugs for at least 6 months with available and complete laboratory results.


RESULTS
Medical records of 337 children meeting enrollment criteria were included in the study. The median age was 63 months with equal male to female ratio. Following 6 months of HAART, prevalence of anemia (Hemoglobin (Hb) <10 g/dl) declined significantly from 35.9 to 16.6 % a nearly 50 % reduction in the risk of anemia RR = 0.56 [(95 % CI 0.44, 0.70) p < 0.001]. There was significant increase in Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and platelets above the baseline measurements (p < 0.0001) and a significant decline in total white blood cell counts >11,000 cell/mm(3) but a none significant decrease in red blood cells (RBC). Pre-HAART, World Health Organization (WHO) stage 3 and 4 was associated with a ten-fold increased likelihood of anemia. Chronic malnutrition was associated with anemia but not wasting and immunologic staging of disease.


CONCLUSIONS
Hematological abnormalities changed significantly within 6 months of antiretroviral therapy with significant increase in hemoglobin level, MCV, MCH and platelet and decrease in WBC and RBC.
Department of Paediatrics and Child Health, Egerton University, P.O. Box 536-20115, Egerton, Kenya ; P.O. Box 2275-20100, Nakuru, Kenya.
Elizabeth Gathoni
EG
Kibaru
Department of Paediatrics and Child Health, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
Ruth
R
Nduati
Department of Paediatrics and Child Health, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
Dalton
D
Wamalwa
Department of Paediatrics and Child Health, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya ; Paediatric Hematology and Oncology, University of London, London, UK.
Nyambura
N
Kariuki
Changes of hematological parameters; Hematological abnormalities; Paediatric HIV infection