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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 234-242

Human immunodeficiency virus-associated thrombocytopenia: Profiling hematological changes in the human immunodeficiency virus-infected and AIDS patients


1 Department of Periodontology, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
2 Department of Oral Medicine and Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
3 Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
4 Department of Oral Medicine and Radiology, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
5 Department of Administrative Sciences, Fairleigh Dickinson University, Vancouver, Canada
6 Department of Oral Medicine and Radiology, Sri Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
7 Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra, India

Date of Web Publication25-Sep-2018

Correspondence Address:
Dr. Abhishek Singh Nayyar
44, Behind Singla Nursing Home, New Friends' Colony, Model Town, Panipat - 132 103, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_143_18

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  Abstract 


CONTEXT AND AIM: AIDS is an acronym for acquired immunodeficiency syndrome caused by a retrovirus known as human immunodeficiency virus (HIV) which breaks down the body's immune system, leaving the patient vulnerable to a host of life-threatening opportunistic infections, neurological disorders, or unusual malignancies. According to estimates by the WHO and UNAIDS, 35 million people were living with HIV globally at the end of the year 2013. The first AIDS case in India was detected in the year 1986. Seldom studies have been conducted correlating CD4 cell counts and complete blood picture including platelet counts in HIV infected and AIDS patients in the Indian population. The present study was carried-out with the same intent to evaluate the CD4 cell counts and complete blood picture in the HIV infected and AIDS patients and correlate them with the sero-negative controls.
MATERIALS AND METHODS: The present study was a cross-sectional, hospital-based study on patients that were divided into three groups: Group A consisting of 500 patients who were healthy controls without any systemic illness, Group B consisting of 500 patients who were diagnosed as HIV infected, and Group C consisting of 500 patients diagnosed as AIDS patients depending on their CD4 cell counts. Evaluation of complete blood picture was done using Sysmex XP 100, a fully automated analyzer, while CD4 cell counts were evaluated using Partec Cyflow Cell Counter.
STATISTICAL ANALYSIS USED: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and post-hoc Games-Howell test. P-value of <0.05 was considered statistically significant.
RESULTS: The results were found to be statistically significant with P < 0.001 for hemoglobin (Hb), white blood cell (WBC) counts, and platelet counts in the HIV-infected and AIDS patients when compared with the seronegative controls.
CONCLUSION: Hb, WBC counts, and platelet counts were significantly altered in the HIV-infected and AIDS patients when compared with the seronegative controls.

Keywords: Acquired immunodeficiency syndrome, CD4 cell counts, complete blood picture, human immunodeficiency virus


How to cite this article:
Pitale U, Muthusamy D, Verma M, Pal PC, Ayesha H, Murru K, Ratnam M, Nayyar AS. Human immunodeficiency virus-associated thrombocytopenia: Profiling hematological changes in the human immunodeficiency virus-infected and AIDS patients. Indian J Health Sci Biomed Res 2018;11:234-42

How to cite this URL:
Pitale U, Muthusamy D, Verma M, Pal PC, Ayesha H, Murru K, Ratnam M, Nayyar AS. Human immunodeficiency virus-associated thrombocytopenia: Profiling hematological changes in the human immunodeficiency virus-infected and AIDS patients. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 15];11:234-42. Available from: http://www.ijournalhs.org/text.asp?2018/11/3/234/242037




  Introduction Top


AIDS is an acronym for acquired immunodeficiency syndrome caused by a retrovirus known as human immunodeficiency virus (HIV) which breaks down the body's immune system, leaving the patient vulnerable to a host of life-threatening opportunistic infections, neurological disorders, or unusual malignancies.[1] The two known types of this virus include the HIV-1 and HIV-2 which belong to a family of primate Lentiviruses.[2],[3] According to estimates by the WHO and UNAIDS, 35 million people were living with HIV globally at the end of the year 2013.[4] Based on HIV Sentinel Surveillance (2008–2009), it is estimated that 23.9 lakh people are infected with HIV in India, of whom 39% are females and 4.4% are children. The first AIDS case in India was detected in the year 1986.[4] HIV is transmitted by both homosexual and heterosexual contacts, blood and blood products, infected mothers to infants via intrapartum or perinatal routes or via breastmilk, and occupational transmission. There is no evidence till date that HIV transmission can occur as a result of exposure to saliva, tears, sweat, and urine.[5] HIV can infect many tissues; however, there are two major targets of HIV infection: the immune system and the central nervous system. Profound immunosuppression, primarily affecting the cell-mediated immunity, is the hallmark of AIDS. HIV enters the body through mucosal tissues and blood and first infects the T-cells as well as dendritic cells and macrophages. The infection becomes established in lymphoid tissue where the virus may remain latent for long periods. Active viral replication is associated with more infection of cells and progression to AIDS. In addition to the lymphoid tissue, the nervous system is a major target of HIV infection. Macrophages and microglia cells in the central nervous system that belong to the monocyte and macrophage lineage are the predominant cell types in the brain that are infected with HIV.[3] The incidence and severity of several common cutaneous diseases are increased in patients with HIV and this correlates in many instances with the absolute number of CD4 T-helper cell counts. The cutaneous manifestations can occur in all stages of HIV disease and it is a prognostic indicator for the development of AIDS.[6] India carries the third largest number of HIV-infected patients in the world after South Africa and Nigeria.[7] In India, the highest prevalence of HIV/AIDS cases has been observed in Nagaland followed by Mizoram, Manipur, and Andhra Pradesh, according to the latest national AIDS statistics (NACO, HIV Sentinel Surveillance 2012–2013).[8] HIV infection causes depletion of CD4 cells in peripheral blood and lymphoid tissues, causing CD8 cell dysfunction. Quantification of CD4 helper lymphocytes is, thus, essential in the staging and monitoring of patients infected with HIV.[9] With reduced CD4 cell counts in HIV infection, granulocytopenia occurs. When the counts of granulocytes fall <500 per mm3, in the presence of an attendant anatomical barrier damage that follows the viral infection, invasion of the bloodstream by microorganisms is facilitated with resultant sepsis and death. The CD4+T lymphocytes are the primary target of HIV infection because of the affinity of the virus to the CD4+ cell surface marker. Infection with HIV leads to a progressive impairment of cellular functions characterized by a gradual decline of CD4+T lymphocyte levels in peripheral bloodstream which results in an increasing susceptibility to a wide variety of opportunistic, viral, bacterial, protozoal, and fungal infections and also to certain malignancies.[10] Hematological abnormalities are among the most common complications of infection with HIV.[11] Chronic thrombocytopenia develops in approximately one-third of individuals infected with HIV during the course of AIDS.[12],[13] Different studies have been carried out on CD4 cell counts and hematologic parameters in the HIV-infected patients in different parts of the world including Nigeria, Brazil, Thailand, Switzerland, and Ghana. In India, few studies were reported from Uttar Pradesh, Chandigarh, Karnataka, Tamil Nadu, and Manipur. Seldom studies have been conducted correlating CD4 cell counts and complete blood picture including platelet counts in HIV infected and AIDS patients in the Indian population. The present study was carried-out with the same intent to evaluate the CD4 cell counts and complete blood picture in the HIV infected and AIDS patients and correlate them with the sero-negative controls.


  Materials and Methods Top


The present study was a cross-sectional, hospital-based study which was designed to assess the CD4 cell counts and complete blood picture of HIV-infected and AIDS patients and correlate them with the seronegative controls. The study consisted of 1500 patients attending the outpatient department. The said patients were divided into three groups including:

  • Group A: Consisting of 500 patients who were healthy controls without any systemic illness
  • Group B: Consisting of 500 patients who were diagnosed as HIV infected, and
  • Group C: Consisting of 500 patients diagnosed as AIDS patients depending on their CD4 cell counts.


The permission from the Ethical Committee of the institution was obtained before starting the study. In addition, an informed consent was obtained from the patients forming the study sample to participate in the study to analyze their CD4 cell counts and complete blood picture. The patients at the extremes of ages, pregnant women, and those on chemotherapy were excluded from the study because of possible weakened immune status. The patients who did not agree to give consent and were not willing to participate in the study were, also, excluded from the study. All the patients of Groups A and B were explained about the study and a written, signed informed consent was obtained from each patient. The patients were made to sit in the chair comfortably and a detailed history was taken followed by clinical examination which was performed following the protocols of the universal precautions on each patient in the antiretroviral therapy (ART) center with the help of diagnostic instruments and artificial illumination [Figure 1]. All the patients in Group C were similarly explained about the study and the same procedure was followed. The findings were recorded in a specialized pro forma. All the patients were, then, subjected to phlebotomy procedure.
Figure 1: Armamentarium for sample collection

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Phlebotomy procedure

The patients were explained about the procedure. The patient's forearm was rested on the laboratory table comfortably. The antecubital fossa was exposed and the tourniquet was applied about half an inch to two inches above the antecubital fossa. The area was rendered aseptic with 70% ethyl alcohol and using a sterile disposable syringe and 23G needle, a needle puncture was made and maneuvered to enter the antecubital vein and 2 ml of blood was drawn [Figure 2]. The tourniquet was, then, relieved and the needle was removed. Dry cotton was placed on the site of needle puncture on the forearm and instructions were given to apply finger pressure for about 5 min and dispose the cotton. The blood was transferred immediately into the tubes containing ethylenediaminetetraacetic acid (EDTA).
Figure 2: Phlebotomy procedure

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Evaluation of CD4 cell counts in human immunodeficiency virus-infected and acquired immunodeficiency syndrome patients

50 μl of EDTA anticoagulated blood was added to 10 μl of monoclonal antibody and after 15 min of incubation, 1 ml of no lyse dilution buffer was added and the sample tube was attached to the Partec Cyflow Cell Counter [Figure 3] for an automated evaluation of CD4 cell counts in the collected samples.
Figure 3: Partec Cyflow Cell Counter for evaluation of CD4 cell counts

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Evaluation of complete blood picture, hemoglobin, packed cell volume, red blood cell counts, white blood cell counts, and platelet counts in human immunodeficiency virus-infected and acquired immunodeficiency syndrome patients

Complete blood picture was obtained using Sysmex XP 100 [Figure 4]. Sysmex XP 100 is a compact, fully automated three-part differential hematology analyzer. 50 μl of blood was taken as the sample. The process was a 2-step procedure. The automated analyzer sampled the blood and quantified, classified, and described the cell populations using both electrical and optical techniques. Electrical analysis involved passing a dilute solution of the blood through an aperture across which an electric current was flowing. The passage of cells through the current changed the impedance between the terminals. A lytic reagent was added to the blood solution to selectively lyse the red blood cells (RBCs) leaving only the white blood cells (WBCs) and platelets intact. The solution was, then, passed through a second detector. This allowed the counts of RBCs, WBCs, and platelets to be obtained. The platelets were easily separated from the WBCs by the smaller impedance spikes they produced in the detector due to their lower cell volumes. Similarly, optical detection was, also, utilized to gain differential counts of the populations of WBCs. A dilute suspension of cells was, then, passed through a flow cell which passed cells one at a time through a capillary tube past a laser beam. The reflectance, transmission, and scattering of the light from each cell were analyzed by a sophisticated software giving a numerical representation of the likely overall distribution of the cell populations.
Figure 4: Sysmex XP 100 for evaluation of complete blood picture

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Statistical Analysis Used

The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and post-hoc Games-Howell test. P value of <0.05 was considered statistically significant.


  Results Top


The distribution of patients based on age and gender as well as the distribution of male and female patients based on age is shown in [Table 1], [Table 2], [Table 3].
Table 1: Distribution of patients based on age groups

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Table 2: Distribution of patients based on gender

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Table 3: Distribution of male and female patients based on age groups

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CD4 cell counts in human immunodeficiency virus-infected and acquired immunodeficiency syndrome patients

The mean CD4 cell counts in the controls was 1125.38 with a standard deviation of 154.73, in the HIV group was 501.35 with a standard deviation of 140.20, and in the AIDS group was 256.41 with a standard deviation of 67.05. The results were found to be statistically significant with P < 0.001 [Table 4] and [Graph 1].
Table 4: Evaluation of CD4 cell counts in the three groups

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Complete blood picture, hemoglobin, packed cell volume, red blood cell counts, white blood cell counts, and platelet counts in human immunodeficiency virus-infected and acquired immunodeficiency syndrome patients

A mean hemoglobin (Hb) value of 13.75 with a standard deviation of 1.76 was observed in the controls, while a mean value of 13.38 with a standard deviation of 1.87 was observed in the HIV group and a mean value of 12.37 with a standard deviation of 1.18 was observed in the AIDS group. The results were found to be statistically significant in this case either with P < 0.001 [Table 5] and [Graph 2]. A mean packed cell volume (PCV) of 37.88 with a standard deviation of 3.18 was observed in the controls, while a mean PCV value of 38.23 with a standard deviation of 21.24 was observed in the HIV group and a mean PCV value of 37.63 with a standard deviation of 5.46 was observed in the AIDS group. The P value, though, was not found to be statistically significant [Table 5] and [Graph 3]. A mean RBC count of 4.59 with a standard deviation of 0.43 was observed in the controls, while a mean value of 4.57 with a standard deviation of 0.74 was observed in the HIV group and a mean value of 4.64 with a standard deviation of 0.73 was observed in the AIDS group. The P value in this case, too, was not found to be statistically significant [Table 5] and [Graph 4]. A mean WBC count of 8134.84 with a standard deviation of 3988.69 was observed in the controls, while a mean value of 9688.40 with a standard deviation of 2813.78 was observed in the HIV group and a mean value of 10264.00 with a standard deviation of 5819.57 was observed in the AIDS group. The P value in this case was found to be statistically significant with it being <0.001 [Table 5] and [Graph 5]. A mean platelet count of 3.37 with a standard deviation of 0.66 was observed in the controls, while a mean count of 3.21 with a standard deviation of 0.64 was observed in the HIV group and a mean count of 2.92 with a standard deviation of 1.91 was observed in the AIDS group. The P value in this case, too, was found to be statistically significant being <0.001 [Table 5] and [Graph 6]. To summarize, the levels of Hb, WBCs, and platelet counts showed statistically significant results with the levels of Hb and platelet counts significantly decreased in the AIDS group when compared with the HIV group and the controls, while on the other hand, the levels of WBCs were significantly increased in the HIV and AIDS groups as against the controls [Table 5] and [Graph 2], [Graph 5], [Graph 6].
Table 5: Evaluation of complete blood picture and their mean comparison between the groups

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  Discussion Top


HIV infection/AIDS is the most deadly disease which causes devastation to the body by affecting the host's immune system.[14] The pathogenesis of HIV infection is largely attributed to the decrease in the number of T-cells (a specific type of lymphocytes) that bear the CD4 cell surface receptors (CD4+). The immune status of a child and/or adult with HIV can be assessed by measuring the absolute number (per mm3) or percentage of CD4+ cells and this is considered as the standard way to assess and characterize the severity of HIV-related immunodeficiency. Progressive depletion of CD4+T-cells is associated with the progression of HIV disease and an increased likelihood of opportunistic infections and other clinical events associated with HIV including wasting and death. The normal absolute CD4 cell counts in adolescents and adults range from 500 to 1500 cells per mm3 of blood. In general, the CD4 (%age of CD4+ cells or, absolute count) progressively decreases as the disease advances.

The CD4 cell counts usually increase in response to an effective combination ART although this might take many months. The proposed immunological classification outlines four bands of HIV-related immunodeficiency as none, mild, advanced, to severe immunodeficiency. The likelihood of disease progression to AIDS or death without ART increases with increasing immunodeficiency (decreasing CD4 cell counts), opportunistic infections, and other HIV-related conditions, increasingly likely with falling CD4 cell counts, especially below 200 cells per mm3 of blood. Response to ART is affected by the immune stage at which it is started with individuals commencing ART with advanced immunodeficiency (CD4 cell counts >200–350 per mm3) to have better virological outcomes than those who commence with more severe immunodeficiency. Adults starting ART with CD4 cell counts <50 per mm3 have a much greater risk of death. On the contrary, adults who commence ART with mild immunodeficiency do not appear to obtain any additional benefits. Pregnancy does affect the CD4 cell counts although the significance of these changes is not clearly understood and for practical purposes, the immunological classification remains the same. The present study was carried out to evaluate the CD4 cell counts, complete blood picture, and lipid profile in HIV-infected and AIDS patients and correlate them with the seronegative controls.

CD4 cell counts is essential for the assessment of immune status in HIV-infected individuals as the pathogenesis of AIDS is largely attributed to a decrease in absolute CD4 cell counts.[15] Different methods have been implemented in evaluating the CD4 cell counts by different authors. Chanarat et al.[16] used Coulter manual CD4 kit for evaluating the CD4 cell counts. Ghate et al.[17] estimated the CD4 cell counts by using a formula where total leukocyte count was multiplied by lymphocyte %age and divided by 100 and then, multiplied by 100th part of CD4% age. Pasupathi et al.[12] and Srirangaraj and Venkatesha [18] estimated the CD4 cell counts by using fluorescence-activated cell sorter (FACS) count system. Sharma et al.[9] estimated the CD4 cell counts using flow cytometry (SRL, Ranbaxy). Angelo et al.[19] estimated the CD4 cell counts using automated flow cytometer software (Multiset™). Tiwari et al.[20] estimated the CD4 cell counts using flow cytometry absolute cell count system at NPHL. Mbanya et al.[21] estimated the CD4 cell counts using conventional flow cytometry using a Becton–Dickinson (BD) FACS count. Sen et al.[22] estimated the CD4 cell counts using FACS counter. Edathodu et al.[23] estimated CD4 cell counts by standard flow cytometry using FACSCalibur™. Pranitha and Kulkarni [15] estimated CD4 cell counts in BD FACSCalibur™ flow cytometer, an automated multicolor system. In the present study, Partec CyFlow Counter (Partec GmbH, Münster, Germany) was used to estimate the CD4 cell counts as it was relatively small, reputed to be easy to use, and had a high throughput of samples.

In the present study, the mean CD4 cell counts in the controls was 1125.38 with a standard deviation of 154.73, in the HIV group was 501.35 with a standard deviation of 140.20, and in the AIDS group was 256.41 with a standard deviation of 67.05. The results were found to be statistically significant with P < 0.001. A gradual decrease in the CD4 cell counts was observed in HIV-infected and AIDS patients in the present study when compared to the controls where still higher than the mean values were observed in the two studies conducted by Pasupathi et al.[12],[24] who recorded a mean CD4 cell count of 394 in HIV-infected and 191 in AIDS patients and 375 in HIV-infected and 150 in AIDS patients although the results obtained were found in accordance with the results obtained in the studies conducted by Tiwari et al.[20] who recorded a mean value of 281 cells per mm3 and Sharma et al.[25] who observed a mean CD4 cell count of 622.4 in HIV-infected and 245.39 in AIDS patients as against 798.81 in the control group. The values obtained in the present study were found to be slightly higher than the values obtained in the study conducted by Sharma et al.[9] who divided the patients based on their CD4 cell counts into three groups with Group I (10–300), Group II (301–600), and Group III (>600) and obtained a mean of 163.43 in Group I, 325 in Group II, and 502.33 in Group III. The reason for the higher values obtained in the present study than as compared to most of the studies might be due to the difference in the classification of the patients into HIV-infected and AIDS patients based on the CD4 cell counts. In the present study, HIV-infected and AIDS patients were categorized based on their CD4 cell counts with 10–350 and 350–500 cells per mm3 of blood.

The CD4 lymphocytes are the primary target of HIV infection because of the affinity of the virus to the CD4 cell surface receptors (CD4+). Infection with HIV leads to a progressive impairment of cellular functions characterized by a gradual decline in peripheral blood CD4+ lymphocyte levels, which results in an increasing susceptibility to a wide variety of opportunistic viral, bacterial, protozoal, and fungal infections and certain malignancies. Tiwari et al.[20] reported that the CD4 cell counts decreased due to the disruption of the cell membranes of the said cells as Tiwari BR et al.[20] reported that the CD4 cell counts decreased in HIV infection due to the disruption of the cell membranes of the said cells brought-out by the budding of the infecting virus from the surface of the cells as well as the intra-cellular accumulation of the hetero-disperse RNAs and un-integrated DNAs with the progression of the disease process. Furthermore, it has, also, been proposed that an intracellular complexing of CD4 cells with the viral envelope products results in cell killing. Similarly, Tiwari et al.[20] proposed untimely induction of a programmed cell death (apoptosis) as an additional mechanism for CD4 cell loss in HIV infection.

Different methods have been implemented to evaluate the hematologic parameters by various authors. Pasupathi et al.[26] estimated the RBC, WBC, and platelet counts and Hb using fully automated hematology analyzer (Pentra-XL 80) and observed significant decrease in the RBC and platelet counts and Hb while significant increase in the WBC counts in the AIDS patients compared to the HIV-infected patients and controls. Santis et al.[27] estimated blood cell counts by using an ABX Pentra 120 DX automated hematology analyzer. Sen et al.[22] estimated blood cell counts by hematology analyzer and Hb by cyanmethemoglobin method. Aryee Tagoe and Asantewaa,[28] also, estimated the RBC, WBC, and platelet counts and Hb by automated blood analyzer and observed significant decrease in the RBC and platelet counts and Hb while significant increase in the WBC counts in the HIV-positive patients than negative controls. Pranitha and Kulkarni [15] estimated the hematology parameters by using an autoanalyzer and observed a significant increase in the WBC counts and a significant decrease in the platelet counts in AIDS patients when compared to the HIV-infected patients and controls. In the present study, Sysmex XP 100 (Sysmex Corp., Hyogo, Japan) automated analyzer was used for the evaluation of complete blood picture as it has been said to be more reliable, accurate, and less time taking than other methods. The results of the present study were in accordance with the results of the studies conducted by Pasupathi et al.[12] and Mbanya et al.[21] who observed decreased levels of RBC counts, platelets, and Hb and increased levels of WBC counts in the HIV-infected and AIDS patients. The mean value of Hb was 12.37 in AIDS patients in the present study, which was in close relation to the Hb level of 11.34 reported in the study conducted by Treacy et al.[29] while slightly higher than the mean value of 10.20 as reported by Pranitha and Kulkarni,[15] a mean value of 10.20 as reported by Aryee Tagoe and Asantewaa,[28] and 10.8 as reported by Kaloutsi et al.[30] The low levels of Hb as well as the RBC counts might be a result of decreased RBC production and/or, ineffective erythropoiesis seen in the HIV-infected and AIDS patients.

Thrombocytopenia observed in the present study was in accordance with the result reported by Erhabor et al.[31] The degree of thrombocytopenia was, also, found to be directly related to the degree of immunosuppression as was confirmed in the study conducted by Jost et al.[32] Pranitha and Kulkarni,[15] Costello,[33] and Karcher and Frost,[34] also, reported the prevalence of thrombocytopenia in their respective studies. According to Pranitha and Kulkarni,[15] the mechanism of thrombocytopenia in HIV infection appears to involve increased platelet destruction and ineffective platelet production. Most reports indicate that there is significant platelet sequestration and destruction in the spleen in HIV-associated thrombocytopenia. Platelet destruction is predominant early in the course of the disease process, while in the later stages, decreased platelet production is assumed to be the major cause of thrombocytopenia observed in the HIV-infected and AIDS patients.

Akinbami et al.,[35] also, reported a high prevalence of thrombocytopenia in their study. Possible mechanisms for thrombocytopenia that have been reported are increased platelet destruction either caused by the nonspecific deposition of circulating immune complexes on platelets or by the presence of specific antiplatelet antibodies directed against the platelets as well as direct infection of megakaryocytes by the HIV with a subsequent decrease in platelet production. The results of the present study were, also, found to be in accordance with the results of the study conducted by Mir et al.[36] who reported anemia, thrombocytopenia, and various permutations in a majority of the HIV-infected patients. According to the results obtained by Walsh et al.,[37] Karpatkin,[38] and Harbol et al.,[39] chronic thrombocytopenia develops in approximately one-third of the individuals infected with HIV during the course of AIDS.

The results of the present study, although, were not found to be in accordance with the results found in the study conducted by Aryee Tagoe and Asantewaa [28] who observed higher platelet counts in HIV-positive patients compared to the HIV-negative controls. HIV infection is associated with a wide variety of hematological changes as a result of bone marrow defects and immune cytopenia directly resulting from HIV infection, opportunistic infections or, lymphoma as well as the side effects of the drugs used to treat HIV itself or, the compounding infections or, lymphoma. The result of bone marrow defect targeting individual hematological parameters usually leads to severe changes in the profile of these set of patients. In addition, HIV destruction of CD4+ lymphocytes which regulate cellular and humoral immunity by interacting with other T-lymphocytes, B-lymphocytes, macrophages, and natural killer cells does result in decrease in WBC counts with its associated increased infections in these patients.

Merits of the present study

The potential points of the present study include that equal number of controls and HIV and AIDS cases were included following stringent inclusion and exclusion criteria. Automated analyzers were used to evaluate the CD4 cell counts and complete blood picture in the HIV-infected and AIDS patients which were more exact than the conventional methods followed before. Till date, very few studies included these three different parameters in one study. The statistical analysis of the data was done using appropriate statistical tests which included ANOVA with post hoc Games–Howell test for comparison of the parameters in between the groups. All the required standardized precautions were taken while phlebotomy procedure was performed. The ethical concern was taken prior to the start of the study. All the appropriate inclusion and exclusion criteria were followed. A systematic methodology was followed throughout the study starting from sample selection to statistical analysis of the results.

Limitations of the present study

The duration of the disease was not recorded in the present study while the present study did not take into consideration the pre-ART and ART patients distinguishing between the patients as this was not a longitudinal study where a patient follow-up could be done.


  Conclusion Top


Hb, WBC counts, and platelet counts were significantly altered in the HIV-infected and AIDS patients when compared with that of the controls. Further studies are, thus, mandated from across the country with correlation analyses to come to valid conclusions and manage this deadly infectious disease process.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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