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Anaemia and Iron Homeostasis in a Cohort of

HIV-Infected
Patients: A Cross-Sectional Study in Ghana

Rangga Lunesia

Introduction
Anaemia
Iron deficiency : leading cause of anaemia
in the
developing world
iron deficiency anaemia :
3rd leading cause of Disability-Adjusted Life Years
(DALYs) for
top 10 disease burdens for
severe public health problem for
children+pregnant women > 67 countries .

2012: 35.3 mill people living with HIV (Sub-Saharan Africa the most
heavily affected )
Anaemia : common feature of HIV infection (2080%) and occurs in
35% of patients who initiate Highly Active Antiretroviral Therapy
(HAART).
Anaemia at HAART initiation associated with HIV disease
progression and mortality.
Moderate and severe anaemia were associated with an increased
mortality among Tanzanian women with HIV. As HIV disease
severity progresses, the likelihood of developing anaemia
increases.
Micronutrient deficiencies, blood loss from intestinal opportunistic
disease, malaria, TB, and parasitic infections involved in the
development of HIV-associated anaemia

Methodology
Study Design/Site.
comparative cross-sectional
Sexually Transmitted Infections (STI) clinic of the
Tamale Teaching Hospital Northern Region of Ghana
July 2013-December 2013.

Ethical Consent.
The study was approved by the related parties.
Participation was voluntary and written informed
consent was obtained from each.

Study Population.
all patients underwent baseline visit for a structured interview
and laboratory examinations.
319 pats:
219 on HAART (designated On-HAART)
100 HAART-naive pats (designated HAART-naive).

Inclusion :

HIV-positive
18 yo
followed up by the Tamale Teaching Hospital STI clinic on HAART > 3 months
good adherence to therapy (missing <2 doses of 30 doses or <3 doses of 60
doses)

Exclusion :
pregnant
inflammation,(CRP > 8.2 mg/L)

Data Collection and Laboratory Methods.


Questionnaire : data on sociodemography.
Clinical history from pat med records.
5 mL early morning venous blood; 2 mL was dispensed into a vacutainer
tube containing EDTA, 3 mL was dispensed into a serum separator tube
(SST), allowed to clot, and then centrifuged at 3000 g for 5 mins.
Aliquots of the serum were stored at 80C until assays were performed.
Laboratory assays : CD4/CD3 lymphocyte counts and haemoglobin and
red/white cell indices
Serum iron, ferritin, transferrin, and transferrin saturation (TSAT)
Serum CRP : to guide in excluding a rise in serum ferritin due to acute
inflammation.

Data Analysis and Statistics.


Disease progression, indicated by CD4 (CDC):
Stage 1 (500 cells/mm3)
Stage 2(200499 cells/mm3)
Stage 3 (<200 cells/mm3)

Disease progression (WHO) :


mild (Hb 10.512.99 g/dL for men; 10.511.99 g/dL for
women),
moderate (Hb 8.010.49 g/dL),
severe (Hb <8.0 g/dL)

Results
Significantly more females than males on
HAART(Table 1).
On-HAART patientss : significantly higher
CD4/CD3, Hb, haematocrit, MCV, MCH, RDWSD, serum iron, ferritin, and transferrin
saturation than when compared to their
corresponding HAART-nave group.
However, WBC count, serum transferrin, and
TIBC were higher amongst the HAART-naive
pats (Table 2).