HIV in Children

HIV AND HEMATOLOGICAL MANIFESTATIONS

Dr. Ira Shah
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Last Updated : 1st September 2012
Hematological abnormalities in HIV infected patients include anemia, thrombocytopenia and granulocytopenia. Anemia and neutropenia are generally caused by inadequate production due to suppression of bone marrow by HIV infection through abnormal cytokine expression and alteration of the bone marrow microenvironment. Thrombocytopenia is due to immune mediated destruction of platelets in addition to inadequate production. Other etiologies include drugs, secondary opportunistic infections, malignancies and nutritional deficiencies.

HIV and anemia


Anemia is a frequent hematological manifestation of human immunodeficiency virus (HIV) infection. The causes of HIV related anemia are multifactorial. There is increased production of cytokines especially in advanced disease which may block marrow production of red cells, decreased erythropoietin production, opportunistic infections such as Mycobacterium avium complex and Parvovirus B-19, administration of drugs such as Zidovudine, ganciclovir and trimethoprim – sulfamethoxazole and myelophthisis caused by malignancies such as lymphoma. Other uncommon mechanisms for HIV associated anemia postulated are autoimmune destruction of red blood cells, Vitamin B12 deficiency and direct infection of marrow precursor cells.

The prevalence of anemia in patients with acquired immunodeficiency syndrome (AIDS) has been estimated to be 63-95%. Treatment of HIV related anemia requires correction of nutritional deficiencies, blood transfusion, recombinant human erythropoietin and modification of offending medications.

HIV and Neutropenia


Neutropenia in ART naïve HIV infected children is most commonly seen as drug-related toxicity and due to opportunistic infections. Treatment of neutropenia includes granulocyte-colony stimulating factor (G-CSF).

HIV AND HEMATOLOGICAL MANIFESTATIONS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.