Blood haemoglobin measurement as a predictive indicator for the progression of HIV/AIDS in resource-limited setting

Anaemia is a frequent complication of infection with the human immunodeficiency virus (HIV) and may have multiple causes. The objective of this study was to find out if blood haemoglobin measurement could be used as an indicator for the progression of HIV/AIDS in resource-limited setting.

Two hundred and twenty-eight (228) consented People Living with HIV/AIDS (PLWHAs) who were placed in three groups according to their CD4 counts were used in the study. The three groups were those with CD4 counts (1) >or= 500 mm-(3); (2) 200-499 mm-(3); and (3) <200 mm-(3). One hundred (100) sex, age-matched and healthy HIV-seronegative individuals were used as control subjects. Blood haemoglobin, blood haematocrit, Red cell indices which included Mean Cell Volume, Mean Cell Haemoglobin Concentration and Mean Cell Haemoglobin and CD4 count were analysed in all subjects.

The mean blood haemoglobin concentrations in those with CD4 counts <200 mm-(3), 200-499 mm-(3) and >or= 500 mm-(3) (8.83 +/- 0.22 g/dl, 10.03 +/- 0.31 g/dl and 11.3 +/- 0.44 g/dl respectively) were significantly lower when compared with the control group (14.29 +/- 0.77 g/dl) (p < 0.0001). The mean blood haematocrit levels in those with CD4 counts <200 mm-3, 200-499 mm-3 and >or= 500 mm-(3) (23.53 +/- 0.85%, 28.28 +/- 0.77% and 33.54 +/- 1.35% respectively) were also significantly lower when compared with the control group (41.15 +/- 2.15%) (p < 0.0001). The red cell indices were also lower in the subjects when compared with the control group. Using the Pearson's correlation, there was a significant and positive correlation between the blood haemoglobin level and their CD4 counts (r(2) = 0.1755; p < 0.0001).

Anaemia in People Living with HIV/AIDS, if persistent, is associated with substantially decreased survival. From our analysis, there was a decrease in the blood haemoglobin, levels as the HIV infection progressed and our findings are consistent with those of other studies of anaemia as a prognostic factor in HIV infection. Haemoglobin levels could be measured easily where resources for more sophisticated laboratory markers such as viral load or even CD4 lymphocyte count are not available given that measurement of the CD4 lymphocyte count requires flow cytometry, an expensive technique unavailable in many developing countries. Regular measurements could help to determine which patients are at greatest risk of disease progression, allowing these patients to be identified for closer monitoring or therapeutic intervention.