Factors Affecting Haematological Parameters Before and After Introduction of Dolutegravir in Hiv-infected Children at Getrudes Childrens Hospital Comprehensive Care Clinic

Abstract

Haematological abnormalities frequently occur in HIV-infected individuals and are independent risk factors for mortality. Haematological abnormalities are a result of HIV infection and adverse drug reactions from antiretroviral therapy. Global research of antiretroviral therapies has led to the development of safer and less toxic antiretroviral drugs enabling withdrawal of the more toxic first-generation drugs. This study seeks to describe the haematological features of HIV-1 infected children on current combination antiretroviral medication. Objectives: To describe and determine the prevalence of abnormal haematological parameters in children 0-18years who are on follow-up at Getrude’s children’s Hospital before and after switching to dolutegravir based protocols. Secondarily to describe demographic and clinical factors influencing these changes. Methodology: Retrospective cohort study among HIV-infected children 0-18years on Antiretroviral Therapy at Gertrude's Children’s Hospital Nairobi between January 2019-December 2022.. Results: Medical records of217 children meeting inclusion criteria were enrolled. The median age for diagnosis in less than 5 years was 10.8 months, between 6-12 years was 23.4months and in the over 13years was 34.4 months with a higher female to male ratio in the under 5s, and 6-12 year olds. Six months after switching to dolutegravir, haemoglobin levels had significant increase 0.001, MCV and MCH had a significant decrease of 0.01 and 0.02 respectively in the over 13 years. The prevalence of leucopenia rose significantly in the 6-12 age group and over 13 years from 10 to 21.6% and 27.6 to 42.1% respectively, neutropenia declined significantly in all age groups (under 5s 80 to 20% p 0.03, 6-12 21.6 to15% p 0.02 ,over 13 30.3 to 18.4% p 0.001) There was non-significant increase in the white cell count in 6-12age bracket and over 13. An increase in neutrophil count was significant at p 0.02 in the 6-12 years, the prevalence of thrombocytosis and thrombocytopenia after switch in the 6-12 age group and the over 13years declined significantly from 11.7 % to1.7% (p 0.03) and 3.9% to 1.3% (p 0.02) respectively with a non-significant increase of platelet count in the under 5s and 6-12 age group and decline in the over 13years. The prevalence of eosinophilia and eosinopenia declined significantly in the 6-12 years from 3.3 to 1.7% and for the over 13 years from 13.6 to 6.6% respectively and significant increase

in eosinopenia was seen in 6-12 age bracket from 1.7% to 10%. The eosinophil count had a non-significant increase in the under5s and over 13 years. Conclusion: Heamatological parameters improved in all parameters except lymphocytes