Changes in Hematological Profiles and Nutritional Status of HIV Infected Children on Prolonged Antiretroviral Therapy at Kenyatta National Hospital

Abstract

Hematologic abnormalities and malnutrition are among the most common clinicopathological manifestations in children with HIV and they are associated with increased risk of morbidity and mortality. The magnitude and severity of hematological abnormalities and malnutrition in children on prolonged ART is not well known. Short term studies have shown changes in hematological and nutritional parameters of HIV infected children but long-term hematological and nutritional evolution after prolonged ART is not completely understood. The aim of this study was to determine the changes in hematological and nutritional parameters and associated hematological abnormalities and malnutrition in the HIV-1 infected children before and after three years of ART at Kenyatta National Hospital (KNH). This study, which was nested within a preexisting prospective cohort study at KNH, extracted medical records from the parent study and evaluated the changes in hematological and nutritional parameters of 86 HIV infected children aged between 18 months to 12 years, receiving ART at KNH. The mean Hb (g/dl) increased significantly from 10.4 (±SD 2.1) to 12.5 (±SD 1.2) before and after 3 years of ART respectively (p=0.0001). Neutrophil Counts (mm3) decreased significantly from 4.2 (±SD 3.2) to 2.7 (±SD3.2) before and after 3 years of ART respectively (p=0.0001). The mean thrombocyte counts (x109/L) decreased from 297 (±SD170) to 283 (±SD84) before and after 3 years of ART respectively (p=0.4391). Anemia (Hb ≤10gm/dl) decreased significantly from 38.4% to 5.8% before and after 3 years of ART respectively (p=0.0001). Neutropenia increased from 9.3% to 22.1% before and after 3 years of ART respectively (p=0.0209). Thrombocytopenia (THR <125 x 109/L) decreased significantly from 10.6% to 1.2% before and after 3 years of ART respectively (p=0.0091). The mean anthropometric measurements, weight for age (WAZ), weight for height (WHZ), and height for age (HAZ) (z-scores) improved significantly between baseline and after 3 years of ART administration (p<0.0001). The proportion of those who were underweight dropped significantly from 58.8% to 14.1% (p=0.0001) after 3 years of ART, the proportion of those who were stunted dropped significantly from 51.9% to 27.1% (p=0.0028) while the proportion of those who had wasting dropped significantly from 20.0% to 2.7% (p=0.0009) after 3 years of ART. This study confirms that prolonged ART in HIV-1 infected children is associated with changes in hematological and nutritional parameters and that hematological and nutritional abnormalities are common manifestations in these children. Based on these findings we recommended that physicians giving care to HIV infected children should routinely investigate and treat hematological abnormalities and malnutrition before and after ART treatment. Additionally, large scale and longitudinal studies are recommended in order to strengthen and explore in depth the problem of hematological abnormalities and malnutrition associated with HIV disease progression and prolonged ART treatment. Integration of HIV/malnutrition services and further research to determine optimal ART timing, role of supplementary feeding and antimicrobial prophylaxis are urgently required. Further, studies on a larger population of children, to ascertain the role of other factors, such as malaria and micronutrient deficiency, which may contribute to anemia, neutropenia, thrombocytopenia and malnutrition in HIV-1 infected children, are recommended.