Thrombocytopenia in Children Infected with the Human Immunodeficiency Virus: Prevalence among Nigerian Igbo Children

Abstract

Background: Human immunodeficiency virus (HIV) infection is associated with a myriad of hematopoietic abnormalities, of which thrombocytopenia (TP) is a common complication. The condition could predispose to life-threatening hemorrhage.
Objectives: To determine the prevalence of thrombocytopenia among HIV- infected children presenting to the Paediatric HIV Unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Southeast Nigeria, and to determine the effect of HAART on HIV-associated TP.
Methods: This is a cross-sectional descriptive prospective study. Inclusion criteria were confirmed HIV infection (age>18 mo) and presumptive diagnosis (<18mo). Patients were consecutively recruited, demographic data collected and baseline hematological and relevant laboratory indices obtained. Clinical Staging and Immunological Staging were obtained. Adherence counselling and ARV therapy were commenced as indicated. All patients were duly followed up.
Results: Two hundred and thirty-three HIV infected children were seen in the unit between July 1, 2003 and June 30, 2005. Ages ranged from 6 months to 15 years. There were 126 males (54.1%) and 107 females (45.9%). According to WHO Clinical Staging, 41 (17.8%) were in stage 1, 79 (33.8%) stage 2, 82 (35.2%) stage 3, & 31 (13.2%) in stage 4. The CDC Immunological classification showed that 32(13.3%) had no suppression, 71(39.5%) had moderate suppression and 130(56.2%) were severely suppressed. One hundred and sixty-eight (71.9%) children were on antiretroviral (ARV) therapy. Twelve children had thrombocytopenia (platelet count < 100,000 cells/mm3) giving a prevalence of 5.2%. Only one patient among these (8.3%) presented with one of the clinical signs of thrombocytopenia (epistaxis) and needed to be transfused. Most of the patients who had thrombocytopenia were within WHO Clinical Stages 3 & 4 and had severe immunosuppression. However, their platelet counts improved with ARV therapy, which was monitored for varying durations.
Conclusion: Highly active ARV therapy (HAART) is effective in correcting HIV-associated TP. Due to the possibility of life-threatening hemorrhage attendant on thrombocytopenia, routine platelet estimation is advocated as part of the initial laboratory evaluation of all HIV-infected children. It is suggested that severe thrombocytopenia should qualify for recruitment into antiretroviral therapy even when all the usual criteria are not present.

Keywords: thrombocytopenia, HIV/AIDS, platelets, children, Nigeria

Nigerian Medical Journal Vol. 48 (2) 2007: pp. 35-38