hematological abnormalities in Côte d’Ivoire

Details

• Alternative Title:
  Trop Med Int Health
• Personal Author:
  Minchella, PA ; Adjé-Touré, C ; Zhang, G ; Tehe, A ; Hedje, J ; Rottinghaus, ER ; Natacha, K ; Diallo, K ; Ouedraogo, GL ; Nkengasong, JN
• Description:
  Background:
  
  High demand for HIV-services and extensive clinical guidelines force health systems in low-resource settings to dedicate resources to service delivery at the expense of other priorities. Simplifying services may reduce the burden on health systems and pre-antiretroviral therapy (ART) laboratory screening is among the services under consideration for simplification.
  
  Methods:
  
  We assessed the frequencies of conditions linked to ART toxicities among 34,994 adult, ART-naïve patients with specimens referred to the RETRO-CI laboratory in Abidjan, Côte d’Ivoire between 1998 and 2017. Screening included tests for serum creatinine, alanine aminotransferase (ALT), and hemoglobin (Hb) to identify renal dysfunction (estimated glomerular filtration rate<50 mL/min), hepatic abnormalities (ALT >5x upper limit of normal), and severe anemia (Hb <6.5 g/dL), respectively. We considered screening results across four eras and identified factors associated with the conditions in question.
  
  Results:
  
  The prevalence of renal dysfunction, hepatic abnormalities, and severe anemia were largely unchanged over time and just 8.4% of patients had any of the three conditions. Key factors associated with renal dysfunction and severe anemia were age >50 years (adjusted odds ratio (aOR): 2.53; 95% confidence interval (CI): 2.19–2.92; p<0.001) and CD4 <100 cells/μl (aOR: 2.57; 95% CI: 2.30–2.88; p<0.001), respectively.
  
  Conclusion:
  
  The relative infrequency of conditions linked to toxicity in Côte d’Ivoire supports the notion that simplification of pre-ART laboratory screening may be undertaken with limited negative impact on identification of adverse events. Targeted screening may be a feasible strategy to balance detection of conditions associated with ART toxicities with simplification of services.
  
  
• Subjects:
  Adult Anemia Anti-Retroviral Agents Female Health Care Rationing HIV Infections Humans Laboratories, Hospital Liver Failure Male Prevalence Referral And Consultation Renal Insufficiency

  More +
• Keywords:
  Anemia Côte D’Ivoire HIV Toxicity
• Source:
  Trop Med Int Health. 25(4):408-413
• Pubmed ID:
  31960558
• Pubmed Central ID:
  PMC8450936
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; CC/CDC HHSUnited States/
• Place as Subject:
  Cote d'Ivoire
• Volume:
  25
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:485dc5965ad29ec57e84536fb4d72f492beded655256182b5b14b65b807eb26f
• Download URL:
  https://stacks.cdc.gov/view/cdc/110277/cdc_110277_DS1.pdf
• File Type:
  [PDF - 500.39 KB ]