From the Guidelines
A complete blood count (CBC) in a patient with HIV is likely to reveal anemia, leukopenia, and thrombocytopenia, as these are common hematological abnormalities associated with HIV infection, as noted in the 2014 guidelines by the HIV Medicine Association of the Infectious Diseases Society of America 1. The CBC results can vary depending on the stage of HIV infection and the presence of antiretroviral therapy. Some common findings include:
- Decreased white blood cell count (leukopenia), particularly reduced CD4+ T lymphocytes, which are the primary target of HIV
- Neutropenia
- Anemia, typically normocytic and normochromic, resulting from decreased red blood cell production due to chronic inflammation, medication side effects, or opportunistic infections
- Thrombocytopenia (low platelet count), which can result from immune-mediated destruction of platelets or decreased production in the bone marrow These abnormalities can be influenced by various factors, including disease progression, opportunistic infections, malignancies, and medication side effects. Regular CBC monitoring is essential for HIV patients to track disease progression and medication effects, as recommended in the guidelines 1. The severity of these abnormalities often correlates with disease progression, with more pronounced changes in advanced HIV infection. Patients on effective antiretroviral therapy may show improvement in these parameters over time, highlighting the importance of regular monitoring and adjustments to treatment as needed, based on the most recent guidelines available 1.
From the FDA Drug Label
5.1 Hematologic Toxicity/Bone Marrow Suppression Zidovudine should be used with caution in patients who have bone marrow compromise evidenced by granulocyte count less than 1,000 cells per mm3 or hemoglobin less than 9.5 g per dL. Hematologic toxicities appear to be related to pretreatment bone marrow reserve and to dose and duration of therapy. In patients with advanced symptomatic HIV-1 disease, anemia and neutropenia were the most significant adverse events observed In patients who experience hematologic toxicity, a reduction in hemoglobin may occur as early as 2 to 4 weeks, and neutropenia usually occurs after 6 to 8 weeks.
A Complete Blood Count (CBC) in a patient with Human Immunodeficiency Virus (HIV) who is taking zidovudine may reveal:
- Anemia: a reduction in hemoglobin, which may occur as early as 2 to 4 weeks after starting treatment
- Neutropenia: a decrease in granulocyte count, which usually occurs after 6 to 8 weeks of treatment
- Pancytopenia: a reduction in all blood cell types, which has been reported in some cases 2 It is essential to monitor blood counts closely, especially in patients with advanced symptomatic HIV-1 disease, to detect severe anemia or neutropenia and adjust treatment as needed.
From the Research
Hematologic Abnormalities in HIV Patients
A Complete Blood Count (CBC) in a patient with Human Immunodeficiency Virus (HIV) may reveal various hematologic abnormalities, including:
- Anemia: The most frequent hematologic abnormality in HIV patients, with a prevalence ranging from 7.2% to 84% 3, 4
- Thrombocytopenia: A common complication in HIV patients, with a prevalence ranging from 4.5% to 26.2% 3, 5
- Leukopenia: Observed in 18.33% of HIV patients 4
- Lymphopenia: Observed in 49.17% of HIV patients 4
- Pancytopenia: A condition where there is a reduction in all three blood cell types (red blood cells, white blood cells, and platelets) 6
Relationship with CD4 Counts
The hematologic abnormalities in HIV patients have been found to be related to the CD4 counts, with:
- Anemia, absolute lymphocyte count, and thrombocytopenia showing a statistically significant relationship with CD4 counts (P<0.0001, =0.018, and =0.044, respectively) 4
- CD4 counts at the time of presentation not being significantly related to the total leukocyte count and absolute neutrophil count 4
Effect of Antiviral Therapy
Antiviral therapy (ART) has been shown to have a beneficial effect on hematologic abnormalities in HIV patients, with: