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hematological abnormalities in Côte d’Ivoire
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4 2020
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Source: Trop Med Int Health. 25(4):408-413
[PDF-500.39 KB]
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Alternative Title:Trop Med Int Health
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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.
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Pubmed ID:31960558
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Pubmed Central ID:PMC8450936
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Volume:25
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Issue:4
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