Changes in Serum Levels of Haematological and Biochemical Parameters, Erythropoietin and Pro-Inflammatory Cytokines in HIV-Infected Patients at Kenyatta National Hospital-Kenya
Mrama, Jackson Ireri
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There were between 31.6 million and 44.5 million HIV infected people globally by the year 2019, 70% of them in sub-Saharan Africa and Kenya harbored 1.6 million. Anaemia is the most common complications in HIV. Erythropoietin, and the proinflammatory cytokines (TNF-α, IL-6 and CRP) are markers of anaemia. The liver produce CRP and the kidney Epo. Changes in blood cell morphologies, levels of haematological, biochemical parameters, Epo, the proinflammatory cytokines in HIV have not been determined among Kenyans. This study aims at determining changes in the levels of these parameters in HIV infected patients. A total of 184 HIV infected adults seen at KNH and 202 blood donors formed the basis of this study. The HIV infected were grouped into: CD4<200 -, 200-499- and ≥500 cells/mm3 and followed for 6 months. Blood samples for assessing levels of the parameters were taken. SPSS version 21 was used to analyze the data, Shapiro-Wilk test determined the normality of the data. Bootstrap parametric and non-parametric methods were used to raise the power of the low sample sizes of referents. Data was described by medians, 2.5-97.5th centiles, means and standard deviations. Wilcoxon rank-sum test compared independent variables and Kruskal Wallis test compared values between CD4 groups. Among the referents, significantly higher mean values in females than in males were demonstrated in: WBC (p=0.002), N (p =0.004), L (p=0.001), CD4+ cells (p<0.001) and P (p<0.001); while lower mean values were demonstrated in RBC (p<0.001), HB (p<0.001) and E (p=0.004). In Biochemical values, females demonstrated significantly higher mean values than males in ALB (p<0.001), but lower in AST (p=0.001), ALT (p<0.001), ALP (p< 0.001, T.Bil (p=0.004), D.Bil (p<0.001), T.PRT (p<0.001) and CRT (p=0.001). In cytokines significantly higher median values in females were demonstrated in CRP (p<0.00I) and lower in: Epo (p<0. 020), TNF-α (p<0.001) and IL– 6 (p=0.016). During follow up, microcytic hypochromic anaemia coupled with rouleaux of up to 15.4% and 15.4% were demonstrated in ART and ARV – naïve females and up to 50% in ART males. ART females demonstrated significantly higher RBC and HB mean values than ARV females. Macrocytic anaemias together with targets of up to 28.2 %, 50% in ART and ARV-naïve females respectively and up to 25% in both ART and ARV-naïve males were demonstrated. Neutrophilia together with hypersegmentation of up to 15%, 25% in ART and ARV-naïve females respectively and 25% in males; eosinophilia of up to 11.1% in ART females thrombocytosis of up 11.1% in ART females and 25% in males in CD4 ≥ 500 group; Lymphopenia of up to 33% in ART females and 50% in ARV males decreasing with increases in CD4 counts were demonstrated. In all the CD4 groups of all the respondents increases in AST, ALT, and GGT were demonstrated. Increases in ALB and ALP were demonstrated in ARV-naïve females in CD4 < 500 group. Decreases in T.PRT and increases ALB were demonstrated in females. Demonstrated were baseline increases in Epo, TNF-α and decreases in CRP and IL-6 and persistent increase in TNF-α in ART females. Recommendations were: development of gender-based reference ranges for: routine Haematological and Biochemical pararmeters, proinflammatory cytokines and use of L counts in HIV management in resource-limited setting.