Serum erythropoietin in patients with anaemia on haart attending the Kenyatta National Hospital comprehensive care centre.

Abstract

Background: The HIV/AIDS pandemic is one of the leading health challenges in the world and Kenya today. Anaemia is the leading hematological abnormality in HIV/AIDS and an independent contributor to morbidity and mortality. HAART has been shown to be effective in reversing anaemia in HIV/AIDS, however a significant proportion of patients remain anaemic despite being on antiretroviral therapy. Deficiency of erythropoietin has been demonstrated as a cause of anaemia in HIV infected HAART naïve patients. The levels of erythropoietin have not been studied in anaemic patients who are on HAART. Objectives: To determine serum EPO levels of HIV infected anaemic patients who have been on HAART for more than six months. Study design and setting: Cross sectional descriptive study, carried out at a national hospital HIV treatment and follow-up outpatient facility: Comprehensive Care Centre, Kenyatta National Hospital. Methods: A total of 196 HIV elisa positive HAART experienced patients with anaemia visiting the Comprehensive Care Centre were consecutively recruited. They were evaluated by total blood counts, CD4 count, documented WHO clinical stage and serum erythropoietin levels. Serum erythropoietin levels were measured by IMMULITE 2000 Elisa method. Results : A total of 196 HIV positive adult patients with anaemia and who had been on HAART for more than six months were evaluated. A total of 181 (92.3%) were found to have a deficient erythropoietin response to anaemia in HIV, (EPO < 500IU/L). Subjects with a Hb of less than 6.5g/dL were up to 54 times as likely to have elevated EPO levels (OR 54.375 (5.641 - 524.139) p= 0.001) while subjects with a Hb of between 6.5 to 7.9g/dL were 27 times as likely to have elevated EPO levels compared to subjects with Hb of 9.5g/dL and above (OR27.84 (3.322 - 233.312) p=0.002. In this study Hb was the main predictor of erythropoietin response. Conclusion: Erythropoietin deficiency is nearly universal in anaemic patients on HAART for more than six months.