Correlating the Prevalence and Severity of Anaemia amongst HIV Infected Adults Males and Females Attending the Bamenda Regional Hospital, Cameroon

Emmanuel, N Tufon and Ogugua Victor, N

Department of Medical Biochemistry, St Louis University Institute of Health and Biomedical Sciences, Mile Three Nkwen Bamenda, Cameroon

ABSTRACT:

Anaemia is an independent risk factor for disease progression and death in persons with HIV infection. The prevalence and severity of anaemia was therefore correlated amongst 300 Cameroonian adult males and females who were diagnosed with the HIV infection at the Bamenda Regional Hospital. Four different haemoglobin concentrations were used as cut off points to categorize anaemia into mild anaemia (Hb ≤ 10g/dl); clear – cut anaemia (Hb ≤ 9g/dl); severe anaemia (Hb ≤7g/dl) and critically severe anaemia (Hb ≤ 5g/dl). A cell – Dyn 3200 blood analyzer was used to determine the haemoglobin concentration of the different groups of patients. Results obtained showed that the mean haemoglobin concentration of the HIV infected males (10.08 ± 0.4g/dl) significantly decreased (p<0.05) compared to the mean haemoglobin concentration of the HIV free control (14.0 ± 0.14g/dl). The mean haemoglobin concentration of the HIV infected females (8.76 ± 10.5g/dl) also decreased significantly (p<0.05) compared to the HIV free control (12.1 ± 0.8g/dl). The prevalence of mild anaemia, clear – cut anaemia, severe anaemia and critically severe anaemia were 43.3%, 40%, 4.7% and 0% in males and 25.3%, 60%, 4.7% and 10% in females respectively. The results obtained from this study indicates that the severity of anaemia in higher in HIV infected adult females than adult males attending the Bamenda Regional Hospital.

KEYWORDS: Anaemia, Severity, Prevalence, HIV, Cameroon

INTRODUCTION:

The haematological complications of human immunodeficiency virus (HIV) infected patients includes anaemia, lymphopenia and thrombocytopenia (Volberding, 2000). Early in the HIV pandemic, it was recognised that anaemia was a prognostic marker of future disease progression or death, independent of CD₄and viral load (Graeme, 2002). Anaemia is defined as a reduction in the number of circulating red blood cells, the haemoglobin concentration or the volume of packed red cells in the blood (Galloway, 2003). The definition of anaemia normally uses the level of haemoglobin as standard which is normally range of 16 ± 2g/dl for men and 14 ± 2g/dl for women (WHO, 2001). Anaemia impacts a range of dimensions on the quality of life (Ludwig and Strasser, 2001) most commonly due to its association with fatigue. Nevertheless, anaemia continues to have a relatively low priority in health programs. A better understanding of the prevalence and severity of anaemia amongst HIV infected adult males and females in remote parts of Africa like in Cameroon will help in the development of more successful actions. In this paper, we present the results of an investigation into the comparism of the prevalence and severity of anaemia amongst HIV infected adult males and females attending the Bamenda Regional Hospital in Cameroon.

MATERIALS AND METHODS:

Study Area:

This study was conducted at the Bamenda Regional Hospital located in the North West Region of Cameroon. This hospital is bedded with a well developed diagnostic laboratory

Study Group:

A total of 300 (30 – 70 years) HIV infected males and females volunteers and 150 (30 – 70 years) males and females uninfected persons (negative control) were selected from those referred to the hospitals’ laboratory for HIV testing. Selection was based on willingness to take part in the study and proximity. After securing consent from the individuals or accompanying parents, relevant clinical information were obtained from them. The control group were known to have no other infection at the time of blood collection.

Haemoglobin concentration determination:

Haemoglobin concentration was determined using a cell – Dyn 3200 blood analyzer (Abbott laboratory, Germany). A full blood count lyse reagent lysed the red blood cells and converted the released haemoglobin to a coloured chromagen. The sample was then transferred to the haemoglobin flow cell where haemoglobin concentration was measured in grams per decilitre (g/dl).

Statistical Analysis:

Independent sample t – test and one sample t – test were performed with SPSS version 15.0 and differences were considered significant if p<0.05

RESULTS:

Data on the haemoglobin concentration of the adult males and females infected with HIV and the uninfected controls are shown on table 1. The mean haemoglobin concentration of the adult HIV infected males and females significantly decreased compared to the uninfected controls.

Data on the prevalence of the different degrees of anaemia classified as mild anaemia (MA), clear – cut anaemia (CCA), severe anaemia (SA) and critically severe anaemia (CSA) in the different groups are shown on table 2.

Discussion:

Anaemia impacts quality of life and survival in persons with HIV infection. Data on the haemoglobin concentration of the subjects are shown on table 1 while data on the prevalence of the different degrees of anaemia are shown on table 2. The mean haemoglobin concentration amongst the HIV infected adult males significantly decreased compared to the uninfected male controls as shown on table 1. In addition, no cases of critically severe anaemia were recorded amongst adult HIV infected males. In the females infected with HIV, the mean haemoglobin concentration significantly decreased compared to the uninfected control. There were in addition 15 (10%) cases of critically severe anaemia which is a serious cause for concern. Studies on HIV and other areas of medicine indicated that values of haemoglobin concentration immediately below the normal values are often associated with certain symptoms especially fatigue (Groopman, 1998; Sobrero et al, 2001). The decrease in haemoglobin concentration observed in HIV patients may be due to inadequate intake of iron and other nutrients, poor absorption of iron both systemic and chronic infections (Galloway, 2003; WHO, 2000) and could also be due to excess haemolysis of red blood cells. Other researchers have associated the decrease to be due to neoplasm and medications (De Marchi et al, 1993; Volberding, 2000; Gordeux et al, 2001; Moore and Forney, 2002).

The prevalence of anaemia in HIV infected patients has continued to be of interest to public health researchers in both developed and developing countries (Walker et al, 1988) but it is often difficult to compare the prevalence rates reported from such studies (Alumanah and Ngwanguama, 2007). To eliminate potential confusion caused by the rather over simplified classification of anaemia into either mild or severe, we grouped anaemia into four categories. This classification is required to distinguish borderline cases of anaemia from clear – cut and critically severe cases which would require different interventions. The prevalence of the different degrees of anaemia observed in this study especially amongst the adult females infected with HIV deserve an urgent attention in the management of anaemia amongst the patients not only because anaemia is an independent risk factor for disease progression but also for the risk of death which increases when haemoglobin concentration falls as low as 5.0g/dl. This results presented will help in designing workable strategies aimed at improving the haemoglobin concentration amongst HIV infected patients especially in remote areas in Africa.

Table 2: The Prevalence of the Different Degrees of Anaemia in HIV Infected Adult Males and Females

Classes of Anaemia

Prevalence

Males(N=150) Females (N=150)

MA (Hb ≤ 10.0g/dl)

CCA (Hb ≤ 9.0g/dl)

SA (Hb ≤ 7.0g/dl)

CSA (Hb ≤ 5.0g/dl)

68 (45.3%) 38 (25.3%)

60 (40%) 90 (60%)

22 (14.7%) 7 (4.7%)

0 (0%) 15 (10%)

ACKNOWLEDGMENT:

Our sincere gratitude goes to the then director Dr. Wefuan, Dr Awasome who was in charge of ethical clearance and the chief technologist of the laboratory unit Mr Chi Frankline all of the Bamenda Regional Hospital, Cameroon for their assistance during the study.

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Received on 23.05.2012

Modified on 28.05.2012

Accepted on 30.05.2012

Research J. Pharmacology and Pharmacodynamics. 4(4): July –August, 2012, 225-227