Associated factors and prognostic implications of neutropenia in individuals with HIV/AIDS

Neutropenia frequently presents as a hematological manifestation among people living with HIV/AIDS (PLWHA). This study explores the factors associated with neutropenia in PLWHA and its prognostic significance.

We conducted a retrospective case-control study of the clinical data from 780 cases of individuals living with HIV/AIDS, who were admitted to Zhongnan Hospital of Wuhan University over the period from January 2016 to September 2020. We categorized the patients into two different groups based on absolute neutrophil Count (ANC): neutropenia group (ANC < 2.0 × 10⁹/L, 33.7%) and non-neutropenia group (ANC ≥ 2.0 × 10⁹/L, 66.3%). We analyzed the co-infections, blood routine test, infection indicators, lymphocyte subpopulation, bone marrow cell cytology, bone marrow morphology in both groups. Additionally, we analyzed the prognosis of the patients.

The results of multifactorial logistic regression showed that increased C-reactive protein (CRP) (p<0.001, adjusted odds ratio [AOR] = 0.984, 95% CI:0.975-0.993), Monocyte (MONO) (p = 0.011, AOR = 0.091, 95% CI: 0.013-0.637), CD19⁺B lymphocytes (p = 0.008, AOR = 0.990, 95% CI: 0.983-0.997), Bone marrow granulocyte (p = 0.017, AOR = 0.936, 95% CI: 0.883-0.992) were protective factors for neutropenia in PLWHA. Kaplan-Meier survival curve analysis showed that Grade 2 neutropenia group (ANC<0.5 × 10⁹/L) had a worse prognosis than Grade 1 neutropenia group (0.5 × 10⁹/L ≤ ANC<2 × 10⁹/L, p = 0.019) and non-neutropenia group (ANC ≥ 2.0 × 10⁹/L, p = 0.008). Older age (p = 0.002), lower hemoglobin levels (p = 0.001), and a reduced proportion of bone marrow granulocytes (p = 0.002) were associated with a poorer prognosis in PLWHA.

HIV infection can lead to reduced neutrophil counts and damage to the immune system through multiple pathways. Severe neutropenia results in a worse prognosis, making timely diagnosis and treatment of neutropenia in this population essential.