ISSN 2997-1036
International Journal of Hematology | Vol. 2, No. 10, October 2011 | pp. 73–80
DOI: 10.46882/2011/IJH/000022
Original Article
Title: Hematological changes and myelosuppression kinetics in HIV-positive patients initiating zidovudine-based highly active antiretroviral therapy
Names of Authors: G. M. Babalola¹, I. N. Okoye², K. S. Abubakar³
Authors’ Affiliations: ¹Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria; ²Department of Medicine, University of Nigeria, Nsukka, Nigeria; ³Department of Pathology, Bayero University, Kano, Nigeria
Abstract: Zidovudine-induced bone marrow suppression limits the therapeutic durability of first-line antiretroviral regimens. This prospective cohort study investigated the timeline, severity, and hematological predictors of myelosuppression in 150 treatment-naive HIV-infected adults initiating highly active antiretroviral therapy containing zidovudine (300 mg twice daily). Full blood counts and CD4 lymphocyte counts were monitored at baseline, 2 weeks, 4 weeks, 8 weeks, and 24 weeks. The prevalence of treatment-emergent anemia (hemoglobin < 10.0 g/dl) was 28.7% (43 of 150) within the first 8 weeks, with severe anemia (< 7.0 g/dl) developing in 6.7% of patients. Concurrently, absolute neutrophil counts declined by a mean of 34.5% from baseline values, whereas mean corpuscular volume values increased progressively from 82.4 fl to 104.6 fl by week 24, acting as an index of therapeutic adherence. Multivariable logistic regression identified a baseline CD4 count below 100 cells/μl and a baseline hemoglobin below 11.0 g/dl as independent risk factors for severe macrocytic anemia (odds ratio = 3.42, P < 0.01). Early, intensive hematological monitoring during the initial 8 weeks of zidovudine therapy is critical to safely managing severe cytopenias.
Keywords: HIV, antiretroviral therapy, zidovudine, anemia, myelosuppression
Manuscript Timeline: Received: July 05, 2011; Revised: August 20, 2011; Accepted: September 10, 2011; Published: October 14, 2011