Selected Inflammatory and Thrombotic Indicators Among Persons Living With HIV Infection In Southern Nigeria

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African Journal of Laboratory Haematology 

and Transfusion Science Volume 1, Issue 2&3: page 173–179 | 2022. ARTICLE ID: 2022–AJLHTS–0017 

www.hbtssn.org/ajlhts ISSN (Print):2814–0591; (Online): 2814–0605 

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ORIGINAL ARTICLE 

Selected Inflammatory and Thrombotic Indicators Among Persons Living With HIV Infection In Southern Nigeria Abunimye Dennis A‘ * Akwiwu Euphoria C‘ Anyanwu Stanley O’Onukak Eme E‘ Akpotuzor Josephine O 

‘Department of Haematology and Blood Transfusion Science, University of Calabar, Calabar. 

Department of Histopathology and Cytology, University of Calabar, Calabar. 

Abstract Introduction: Although viremia has been greatly addressed in the management of human immunodeficiency virus (HIV) infection by the advancement in antiretroviral therapy, not all HIV–associated morbidities have been resolved. Observations of increased cardiovascular risk in relation to antiretroviral therapy have been reported. Full blood count continues to be useful in disease management, and efforts are directed towards optimising its utility in medical practice. Derivatives of blood cell counts have in recent times proved to be informative with regards to the inflammatory thrombotic cycle. The utility of these derived parameters in HIV within the study locality is worth exploring. 

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Corresponding Author Dr Euphoria C. Akwiwu Department of Haematology and Blood 

Transfusion Science, University of Calabar, Calabar Nigeria 

Methods: This single–site study was carried out at University of Calabar Teaching Hospital in Calabar, Cross River State of Nigeria. White blood cell and platelet counts were carried out by automation, while blood cell ratios were calculated. Statistical analysis of data was done using SPSS 22.0. A p–value of <0.05 was considered to infer a statistically significant difference. 

Email: ecakwiwu@gmail.com 

Received: May 01, 2022 Accepted: August 26, 2022 Published: September 30, 2022 

Results: Significant reductions of white blood cell parameters were recorded in HIV, particularly among infected persons on antiretroviral therapy. Platelet count and plateletcrit were significantly lower, while mean platelet volume and platelet distribution width were higher in newly diagnosed persons compared to HIV–infected subjects on therapy and control subjects. Platelet–to–lymphocyte ratio was significantly higher among subjects on therapy compared to the rest of the groups. 

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Conclusion: Increase in platelet count following antiretroviral therapy could be posing a risk of platelet–driven morbidities as typified in the observed elevated thrombotic marker. 

Key words: HIV, immunity, antiretroviral therapy, thrombosis 

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directed towards optimising the utility in medical practice. This is particularly in recognition of increasing burden of healthcare cost. Thus, derivable parameters that are at no additional cost to patients are gaining advocacy especially if such parameters are observed to be significantly deranged in disease states. Derivatives of blood cell counts have in recent times proved to be informative with regards to the inflammatory–thrombotic cycle (15,16). The neutrophil–to–lymphocyte ratio and platelet–to–lymphocyte ratio, in particular, are suggestively better morbidity indicators compared to the individual parameters both in health and disease conditions (17,18). The utility of these derived parameters in HIV within the study locality is yet to be explored hence the present study. 

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Introduction The management of human immunodeficiency virus (HIV) infection has undergone tremendous reviews since the discovery of this medical condition. Quite early in the wake of identifying this disease entity, studies into its pathogenicity and pathophysiology brought to light the basic knowledge of its immune–related nature (1,2,3). At the forefront of the disease mechanism is the debilitating interference with 

1. y. Hence the emergence of the CD4 cell count as a biomarker for prognosis and disease monitoring served as a major breakthrough in the management of HIV infection (4,5,6). Since then, other sensitive indicators of morbidity and overall survival such as viral load and anaemic indices have been integrated into the protocol for effective HIV management (7,8,9). Interestingly, with the advancement in HIV chemotherapy, not all HIV –associated morbidities have been addressed. It would appear that certain complications are being observed to be prevalent among infected persons on antiretroviral therapy (10,11,12,13). One such aspect of deep concern is that of HIV–associated cardiovascular involvement. Observations of increased cardiovascular risk in relation to antiretroviral therapy have been made by previous studies. More interesting is the identification of components of the full blood count, such as variations in blood cell size, as markers in this emerging field of concern(14). 

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Materials and methods 

The present study was carried out among a total of 90 subjects at the University of Calabar Teaching Hospital at Calabar, Nigeria. Purposive sampling technique was used to enrol 30 participants each for the categories of newly diagnosed, subjects on HAART and control subjects. The subjects were between 25 and 45 years of age. Ethical approval was sought and duly obtained from the University of Calabar Teaching Hospital Health Research Ethics Committee, while informed consent was obtained from each participant. 

Blood sample was appropriately obtained from each subject for w 

for white cell and platelet automated estimations using Mindray BC–5000 

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Abunimye et al / Inflammatory and Thrombotic Indicators in HIV Infection 

Haematology Analyzer (Mindray Medical Discussion International Limited, China). This equipment This study observed lower total and differential was controlled and calibrated according to white blood cell counts in HIV, particularly manufacturer‘s instructions to ensure its fitness among infected persons on antiretroviral for use. Blood cell ratios were mathematically therapy. Cytopenia in relation to HIV infection derived. Data generated were entered into has been among the major haematological Microsoft excel spreadsheet and analysed using derangements observed in its management. This Statistical Package for Social Sciences (SPSS) is thought to be driven by the mechanism of software version 22.0. Frequencies and one– haemato–suppression, thus suggesting the way analysis of variance were used for analysis possibility of reversal where viral load is of data. The least significant difference (LSD) sufficiently reduced (19,20,21,22,23). To this Post Hoc Test accompanied the ANOVA for end, effective administration of antiretroviral interpretation of significant variance. Statistical therapy is expected to ameliorate HIV significance was drawn at a p<0.05. 

associated cytopenia in addition to arresting 

viral replication and immune deficiency. Results 

However, there appears to be conflicting This research on selected inflammatory and reports regarding values of peripheral white thrombotic indicators among persons living blood cell lineages following antiretroviral with HIV infection in Southern Nigeria was therapy. Decline in total white blood cell count carried out at the University of Calabar together with the granulocyte and lymphocyte Teaching Hospital, Calabar. A total of 90 male sub–populations following administration of and female subjects were enrolled in the study. antiretroviral therapy have also been reported In terms of HIV status of the participants, those by previous studies (24,25). on HAART were made up of 33.3%, those that The present study also recorded lower were newly diagnosed were 33.3%, while sero– platelet count and plateletcrit alongside higher negative control subjects were also 33.3%. mean platelet volume and platelet distribution 

The total white blood cell count (WBC) width in the newly diagnosed HIV subjects. and absolute monocyte count varied The risk of thrombocytopenia has been linked significantly across the groups. Absolute to the HIV pathophysiology. Possible neutrophil and lymphocyte counts were mechanisms for its occurrence include observed to be significantly lower in HIV increasing viremia, immune response to viral subjects on HAART compared to newly invasion, disease progression and adverse effect diagnosed and control subjects (Table 1). from certain antiretroviral agents (26). There 

Among the platelet parameters, platelet are reports of HIV–associated count and plateletcrit were significantly lower thrombocytopenia with a predominance of the among the newly diagnosed group compared to mild form across the African region. Findings of the other groups, while mean platelet volume these studies reveal a pattern of improved and platelet distribution width were observed platelet count following antiretroviral therapy to be higher in newly diagnosed compared to (27,28,29). In addition, lower platelet count and HIV subjects on HAART and control subjects higher platelet distribution width have been (Table 2). In addition, platelet–to–lymphocyte reported in Calabar, Nigeria (30). The study ratio was significantly higher among subjects on observed that although the finding of lower HAART compared to the rest of the groups as platelet count could arise from insufficient shown on Table 3. 

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the finding of higher platelet distribution width value suggested the later. Platelet distribution width represents the variability in platelet size and is thought to be an important marker of platelet activation (31). 

In the light of the foregoing, increase in platelet count following antiretroviral therapy without a check in platelet activation may be inimical to the management of HIV infection in the long run. Interestingly, as advancement in antiretroviral therapy continues to receive endorsement, there are also reports of associated cardiovascular disease risk (32,33,34). Several studies have linked both the infection and antiretroviral therapy with 

increased risk of platelet-driven cardiovascular events, particularly myocardial infarction (35, 36, 10, 12). Thus, the finding of raised platelet to–lymphocyte ratio among subjects on antiretroviral therapy in the present study quite significant and informative as it reveals the utility of this parameter in determining the risk of cardiovascular complication. In conclusion, improvement of platelet count by antiretroviral therapy could be posing a risk of platelet–driven morbidities as typified in the observed elevated thrombotic marker. 

conflict of Interest: Authors declare no conflict of interest. 

Table 1. White cell parameters of study participants 

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Parameters 

P–value 

Subjects on HAART 

PT 

Subjects newly diagnosed 

(n = 30) 

Control subjects 

(n = 30) 

(n = 30) 

WBC (x 109/1) 

2.36+0.76* 

3.81+1.46% 

4.73+1.47 

0.001 

Neutrophil (x10°/1) 1.09+0.79% 

1.73+1.21 

2.21+1.02 

0.001 

2.08+0.77 

2.00+0.67 

0.005 

Lymphocyte 1.54+0.56% (x109/1) Eosinophil (x 10°/1) 0.71+0.05 

0.12+0.15 

0.11+0.08 

0.166 

Monocyte (x10/1) 

0.24+0.13* 

0.30+0.20* 

0.40+0.32 

0.022 

Key: HAART = Highly active antiretroviral therapy, WBC = White blood cell. *Significantly different from other groups 

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Table 2. Platelet parameters of study participants 

Parameters 

P–value 

Subjects on HAART 

(n = 30) 

Subjects newly Control diagnosed 

subjects (n = 30) 

(n = 30) 

176.87+63.38* 218.67+50.71 

PLT (x 10°/1) 

194.70+57.26 

0.022 

MPV (fl) 

9.57–1.23 

10.35+1.454 

9.55+1.12 

0.027 

PDW (%) 

15.64+0.51 

16.11+0.57% 

15.70+0.94 

0.023 

PCT (%) 

2.01+0.60 

1.62+0.63% 

1.98+0.55 

0.024 

Key: HAART = Highly active antiretroviral therapy, PLT = Platelet count, MPV = Mean platelet volume, PDW = Platelet distribution width, PCT = Plateletcrit. *Significantly different from other groups 

Table 3. Blood cell ratios of study participants 

Parameters 

P–value 

Subjects on HAART 

Subjects newly diagnosed (n = 30) 

Control 

subjects 

(n = 30) 

(n = 30) 

NLR 

0.85+1.04 

0.88+0.63 

1.17+0.79 

0.212 

PLR 

149.30+85.50* 

98.78+57.86 

117.91+41.65 

0.011 

Key: HAART = Highly active antiretroviral therapy, NLR = neutrophil–to–lymphocyte ratio, PLR = platelet–to–lymphocyte ratio Neutrophil. *Significantly different from other groups 

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1. 1. 
2. 15. 
3. 16. 
4. 17. 

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