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Open Access Library Journal
2023, Volume 10, e9580
ISSN Online: 2333-9721
ISSN Print: 2333-9705
DOI:
10.4236/oalib.1109580 Jan. 20, 2023 1
Open Access Library Journal
Prevalence of Anemia among People Living
with HIV/AIDS Starting Antiretroviral Therapy
in the Era of Dolutegravir in Kinshasa,
Democratic Republic of Congo
Berry Bongenya Ikolango1,2, Mariano Lusakibanza3, Gauthier Mesia Kahunu3,
Baudoin Buassa Bu Tsumbu4, Richard Kalala Lunganza4, Erick Kamangu Ntambwe2,4*
1Faculty of Medicine, Bel Campus Technological University, Kinshasa, Democratic Republic of Congo
2“HIV/AIDS Focus” Research Group, Kinshasa, Democratic Republic of Congo
3Clinical Pharmacology Unit, Department of Pharmacology, Faculty of Medicine and Pharmaceutical Sciences,
University of Kinshasa, Kinshasa, Democratic Republic of Congo
4Service of Molecular Biochemistry, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa,
Democratic Republic of Congo
Abstract
Background:
Anemia remains the most frequent hematological complication
during HIV/AIDS infection.
Objective:
The objective of this study was to de-
termine the prevalence of anemia among People Living with HIV (PLHIV)
who start AntiRetroViral treatment in Kinshasa in
the era of Dolutegravir.
Methods:
This study was a descriptive cross-
sectional study to determine the
prevalence of anemia in PLHIV at the start of ARV Treatment (ART) in 13
Outpatient Treatment Centers (OTC) in Kinshasa. The patient inclusion pe-
riod was from October 04, 2021 to February 15,
2022. Patients included in the
present study were HIV type 1 infected, ART naïve,
over the age of 18 and
had signed informed consent for participation. The parameters of interest
were: The hemoglobin level and the clinic of the patients.
Results:
One hun-
dred and nineteen patients were included in this work with an average age of
39.87 ± 12.36 years and extremities of 18 to 69 years. The most represented
age group is that of 36 to 45 years with 37 patients (31.9%). Sixty-seven pa-
tients (56.3%) are female. The average value for Hemoglobin is 10.30 ± 2.33
g/dl. The most represented range of values is that of more than 13 g/dl with
73 patients (69.5%). Forty-nine (49) patients, or 41.5%,
were in clinical stage
3. Fifty-five (55) patients, or 47.0%, had normal clinical status. Conclusion:
How to cite this paper:
Ikolango,
B.B.,
Lu
sakibanza, M., Kahunu, G.M.,
Tsumbu,
B.B.B.,
Lunganza, R.K. and Ntambwe, E.K.
(20
23)
Prevalence of Anemia among People
Living with HIV/AIDS Starting Antiretroviral
Therapy in the Era of Dolutegravir in Kin
-
shasa, Democratic Republic of Congo
.
Open
Access Library
Journal
,
10
: e9580.
https://doi.org/10.4236/oalib.1109580
Received:
November 16, 2022
Accepted:
January 17, 2023
Published:
January 20, 2023
Copyright © 20
23 by author(s) and Open
Access Library Inc
.
This work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
B. B. Ikolango et al.
DOI:
10.4236/oalib.1109580 2
Open Access Library Journal
At the start of ART, 21.0% of patients presented with some form of anemia:
7.6% mild anemia,
8.6% moderate anemia and 4.8% severe anemia. About
half of the patients (41.5%) were at clinical st
age 3 according to WHO and
more than half of all patients (47.0%) had a normal clinical condition.
Subject Areas
HIV
Keywords
Anemia, PLHIV, Start of ART, Kinshasa
1. Introduction
Human Immunodeficiency Virus (HIV) infection and Acquired Immune Defi-
ciency Syndrome (AIDS) are currently a major public health problem world-
wide. According to the United Nations Organization for the Fight against
HIV/AIDS (UNAIDS) report of 2020, the number of People Living with
HIV/AIDS (PLHIV) was estimated at 37.7 million [30.2 million - 45.1 million]
[1]. In the same year, 1.5 million [1.0 million - 2.0 million] people were newly
infected with HIV/AIDS [1]. Sub-Saharan Africa, which bears the greatest bur-
den of the epidemic, remains to this day the most affected region in the world
[1].
Anemia is a problem of reduced oxygen capacity of the blood. This decrease
can be caused by: insufficient number of red blood cells available, insufficient
synthesis of hemoglobin, blood loss (hemolysis), etc. Hence, these deficiencies
are revealed in the laboratory results relating to hemoglobin, hematocrit and red
blood cell levels. These are all products of the bone marrow. Hence anemia
usually occurs when the marrow does not function normally.
Anemia remains the most frequent hematological complication during
HIV/AIDS infection [2]. It affects more than three quarters of people whose
HIV infection is at an advanced stage because they are not on antiretroviral
therapy or because ART is not effective. It is less common in people observant of
the ARV treatment. In either case, it is essential to assess anemia at the onset and
during HIV infection and to treat it because inappropriate treatment can also
worsen the hemoglobin level of an immune-compromised patient [2].
People with HIV/AIDS are more likely than the general population to develop
anemia. Compared to those who do not develop anemia, HIV-infected people
who develop anemia are more likely to die early. It is therefore important to
have concrete evidence on the state of anemia already at the start of treatment.
Hence, the objective of this study was to determine the prevalence of anemia
in People Living with HIV starting AntiRetroViral treatment in Kinshasa in the
era of Dolutegravir.
B. B. Ikolango et al.
DOI:
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2. Methods
2.1. Study Design, Patient and Sample Setting
The present study was a descriptive cross-sectional study aimed at determining
the prevalence of anemia in People Living with HIV (PLHIV) at the start of ARV
treatment (ART) in Outpatient Treatment Centers (OTC) care of PLHIV in
Kinshasa. The patient inclusion period was from October 04, 2021 to February
15, 2022. Sixteen OTCs were included in the study based on their expertise and
accessibility [3].
After reading and signing an informed consent in the OTC, a sample of 5 ml
of blood was taken in a tube with EDTA anticoagulant from the vein of the bend
of the elbow for analyzes of the hemoglobin level in any patient HIV positive by
serology. The hematology analyzer (HumanCount 60TS, Human, Germany) was
used in the biochemistry laboratory with specific reagents according to the man-
ufacturer’s protocol.
2.2. Study Population
The patients included in the present study were infected with HIV type 1, naïve
to ART, aged over 18 years and having signed informed consent for participa-
tion.
2.3. Parameters of Interest
The parameters of interest followed for the present study were: the hemoglobin
level and the clinic of the patients.
2.4. Ethical Consideration
As a whole, this study was approved by the research ethics committee of the
School of Public Health, Faculty of Medicine, University of Kinshasa (ESP/
CE/115/2021). Approval to access the OTC was obtained from each competent
authority of the various institutions included. Prior to inclusion, fully informed
consent was obtained from each patient. The samples in the OTCs were taken by
the technical teams of the centers. The results of the analyses were returned to
the centers concerned.
2.5. Statistical Analyzes
The analyses were carried out using SPSS software version 26 (Statistical Package
for Social Sciences, IBM). Only available data were analyzed, missing data were
considered completely random. Continuous variables were presented as mean ±
standard deviation.
2.6. Operational Definitions
Anemia is defined as a condition in which the number of red blood cells is low.
Red blood cells contain hemoglobin, a protein that allows them to carry oxygen
from the lungs to all tissues in the body. It results in a hemoglobin level of less
B. B. Ikolango et al.
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than 10 g/dl in whole blood (mild anemia = 10 to 7 g/dl; moderate anemia = 7 to
4 g/dl; severe anemia = <4 g/dl).
3. Results
One hundred and nineteen (119) patients were included in this study according
to the inclusion criteria with a mean age of 39.87 ± 12.36 years and extremes of
18 to 69 years. The most represented age group with 37 patients (31.9%) is that
of 36 to 45 years; followed by those aged 26 to 35 (20.7%), those aged 46 to 55
(19.0%) and those aged 18 to 25 (16.4%).
Sixty-seven (67) patients, or 56.3%, were female while 52 (43.7%) were male,
thus presenting a sex ratio of 1.29 in favor of women.
Table 1 presents the data mentioned above.
Forty-nine patients (49), or 41.5%, were at clinical stage 3; followed by 40 pa-
tients (33.9%) who were at clinical stage 1, 18 patients (15.3%) at clinical stage 2
and 11 patients (9.3%) at clinical stage 4. Fifty-five (55) patients, or 47.0%, had a
normal clinical condition; 39 patients (33.3%) had a good clinical condition, 22
patients (18.8%) a poor clinical condition and 1 patient (0.9%) a pre-moribund
clinical condition (Table 2).
The average value for Hemoglobin is 10.30 ± 2.33 g/dl with extreme values of
3.40 to 16.59 g/dl. The range of values most represented with 73 patients (69.5%)
is that of more than 13 g/dl; followed by that of 10 to 13 g/dl (9.5%), that of 4 to
7 g/dl (8.6%), that of 7 to 10 g/dl (7.6%) and that of less of 4 g/dl (4.8%). Table 3
presents the present values.
No significant correlation was presented between the anemia and the clinic of
the patients on inclusion (Table 4).
4. Discussion
The objective of this study was to determine the prevalence of anemia in People
Table 1. Distribution of the population by gender and by age group.
Parameters
Patients
Values
Percentage
Sex (N = 119)
Female 67 56.3
Male 52 43.7
Age group (N = 116)
18 - 25 19 16.4
26 - 35 24 20.7
36 - 45 37 31.9
46 - 55 22 19.0
56 - 65 11 9.5
>65 3 2.5
B. B. Ikolango et al.
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Table 2. Patient clinic at inclusion.
Clinic of patients
Frequency
Percentage
Clinical Stage according to WHO (N = 118)
Stage 1 40 33.9
Stage 2 18 15.3
Stage 3 49 41.5
Stage 4 11 9.3
Clinical State of patient (N = 117)
Normal 55 47.0
Good 39 33.3
Bad 22 18.8
Pre-moribund 1 0.9
Moribund 0 0
Table 3. Range of hemoglobin values.
Values of hemoglobin (g/dl)
Frequency
N
= 105
Percentage
<4 5 4.8
4 - 7 9 8.6
7 - 10 8 7.6
10 - 13 10 9.5
>13 73 69.5
Table 4. Correlation between the clinic of the patients and the anemia.
Etat
Clinique
Patient
Stade
Clinique
Du Patient
Examen
Biologique
Du Patient
Etat Clinique Patient
Correlation de
Pearson
1 .524** -.193
Sig. (two
-sided) .000 .051
N
117 117 103
Stade Clinique
Du Patient
Correlation de
Pearson
.524** 1 -.143
Sig. (two
-sided) .000 .149
N
117 118 104
Examen Biologique
Du Patient
Correlation de
Pearson
-.193 -.143 1
Sig. (two
-sided) .051 .149
N
103 104 105
**The correlation is significant at the 0.01 level (two-sided).
B. B. Ikolango et al.
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Living with HIV (PLHIV) who start AntiRetroViral treatment in Kinshasa dur-
ing the era of Dolutegravir. One hundred and nineteen (119) ART-naïve PLHIV
were included for this work according to the inclusion criteria in 16 Outpatient
Treatment Centers (OTC) dispersed in the different districts of Kinshasa, Dem-
ocratic Republic of Congo.
The mean age of the patients at inclusion is 39.87 ± 12.36 years with extremes
of 18 to 69 years. The most represented age group with 37 patients (31.9%) is
that of 36 to 45 years; followed by those aged 26 to 35 (20.7%), those aged 46 to
55 (19.0%) and those aged 18 to 25 (16.4%). These results, which present the age
group of 36 to 45 years as dominant in the population, are also found in various
publications on PLHIV in Kinshasa for recent years [4] [5].
Sixty-seven (67) patients, or 56.3%, were female while 52 (43.7%) were male,
thus presenting a sex ratio of 1.29 in favor of women. These results, which show
a predominance of the female sex in a cohort of PLHIV, are similar to the trend
in relation to the sex ratio presented by various works that have been published
on PLHIV for Kinshasa in recent years [4] [5].
Forty-nine patients (49), or 41.5%, were at clinical stage 3; followed by 40 pa-
tients (33.9%) who were at clinical stage 1, 18 patients (15.3%) at clinical stage 2
and 11 patients (9.3%) at clinical stage 4. Fifty-five (55) patients, or 47.0%, had a
normal clinical condition; followed by 39 patients (33.3%) who had a good clin-
ical state, 22 patients (18.8%) a bad clinical state and 1 patient (0.9%) a
pre-moribund clinical state. Similar results have been found by different authors
for Kinshasa [4] [5] [6]. They present a late diagnosis of patients which impacts
on the care and prognosis of the follow-up of PLHIV because of the advanced
stage of the infection during screening.
The average value for Hemoglobin is 10.30 ± 2.33 g/dl with extreme values of
3.4 to 16.59 g/dl. The range of values most represented with 73 patients (69.5%)
is that of more than 13 g/dl; followed by that of 10 to 13 g/dl (9.5%), that of 4 to
7 g/dl (8.6%), that of 7 to 10 g/dl (7.6%) and that of less of 4 g/dl (4.8%). In the
present cohort at the start of ART, 21.0% of patients presented with some form
of anemia: 7.6% mild anemia, 8.6% moderate anemia and 4.8% severe anemia. It
is therefore important to monitor the hemoglobin level of PLHIV already at the
start of TRAV so that the latter is effective and accommodating for the patient,
such as the choice of molecules to be prescribed for treatment. Previous data
presented an average of 9.30 ± 2.90 g/dl in PLHIV without taking into account
the duration of ART [5], and a prevalence of 55.1% in the population of adult
PLHIV without taking into account clinical stages of patients [7]. These results
from the literature are justifiable by the duration of treatment and the AntiRe-
trovirals used by PLHIV because anemia can also be caused by ARVs such as
Azythromicine (AZT), as well as other antimalarial and anti-malarial drugs,
Hepatitis C.
5. Conclusion
In the present cohort, at the start of ART, 21.0% of patients presented with some
B. B. Ikolango et al.
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form of anemia: 7.6% mild anemia, 8.6% moderate anemia and 4.8% severe
anemia. About half of the patients (41.5%) were at clinical stage 3 according to
WHO and more than half of all patients (47.0%) had a normal clinical condition.
It is therefore important to monitor the hemoglobin level of PLHIV already at
the start of ART so that the latter is effective and accommodating for the patient,
such as the choice of molecules to be prescribed for treatment.
Acknowledgements
The authors would like to thank the patients of the various centers who agreed
to participate in this work, all the teams of service providers from the outpatient
treatment centers of Kinshasa who participated, as well as all the administrative
authorities who facilitated the progress of the work. A very special thank you is
addressed to the Biochemistry Laboratory of the Faculty of Pharmaceutical
Sciences of the University of Kinshasa.
Conflicts of Interest
The authors declare no conflict of interest for this study.
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List of Abbreviations and Acronyms
ART: AntiRetroViral Treatment;
ARV: AntiRetroViral;
DRC: Democratic Republic of Congo;
DTG: Dolutegravir;
HIV: Human Immunodeficiency Virus;
OTC: Outpatient Treatment Center;
PLHIV: Person Living with Human Immunodeficiency Virus.
