Immunohematologic parallels and paradoxes: Africa vs Russia in the HIV era- a narrative review

Human Immunodeficiency Virus (HIV) infection significantly impacts the immune system, often resulting in various hematological complications, including anemia, neutropenia, and thrombocytopenia. These cytopenias are influenced by several factors, including the direct effects of HIV on the bone marrow and the side effects of antiretroviral therapy. However, there are notable ethnoracial differences in the immunohematological profiles of HIV-infected individuals, particularly between African and Russian populations. Africa, with its high prevalence of co-infections such as malaria, tuberculosis, and helminthiasis, presents unique challenges in managing HIV-related cytopenias. In contrast, in Russia, chronic comorbidities such as hepatitis and alcohol use significantly influence the immune and hematological responses to HIV. These differences underline the importance of considering both genetic and environmental factors when diagnosing and managing HIV-related hematological disorders. While both regions face substantial HIV burdens, the immunohematologic outcomes differ considerably due to regional co-morbidities and genetic predispositions. In Africa, malaria and helminth infections frequently exacerbate anemia, neutropenia, and thrombocytopenia, while in Russia, liver diseases, alcohol use, and chronic viral infections contribute to myelosuppression and hematological abnormalities. Moreover, certain genetic factors, such as Benign Ethnic Neutropenia in African populations, complicate the interpretation of hematological data. These disparities necessitate region-specific approaches to diagnosis, treatment, and management, tailored to address the unique challenges posed by each population's distinct disease environment and health care system.