Prevalence of anaemia and the relationship between haemoglobin concentration and CD4 count in HIV positive children on highly active antiretroviral therapy (HAART) in Lagos, Nigeria

Background
Anaemia is commonly reported among people living with HIV, however the prevalence of anaemia in highly active antiretroviral therapy (HAART) experienced Nigerian children has not been well defined. This study addressed this gap and evaluated the relationship between haemoglobin concentration and CD4 count in the presence of HAART.

Method
Participants (n=164) were aged between 5 and 12 years, living with HIV and had received HAART for a minimum of 12 months. All participants were outpatients at two HIV treatment centres in Lagos, Nigeria. Haemoglobin concentration and CD4 count were determined as part of baseline measurements for an ongoing randomized controlled multivitamin study (NCT02552602). Prevalence of anaemia and immune deficiency were determined based on haemoglobin concentration and CD4 count (respectively) of study participants. Pearson correlation was used to evaluate the correlation between haemoglobin concentration and CD4 count. T test was used to determine if statistical differences in haemoglobin concentration existed among participants with immune deficiency and no significant immune deficiency.

Result
At 54.2%, anaemia was still highly prevalent in HAART experienced children in Lagos, Nigeria. The prevalence of anaemia among immune deficient participants (CD4 count <500 cells/ mm3) was not significantly different from the prevalence of anaemia among participants with no significant immune deficiency (CD4 count ≥ 500 cells/mm3) (52% v 55%, Pearson Chi- Square, P= 0.783). Haemoglobin concentration was not significantly correlated with CD4 count (Pearson correlation (r) = 0.081, P = 0.302) and haemoglobin concentration could not be used as a predictor of immune status (Binary logistic regression, OR 1.461, 95% CI 0.866 – 2.464, P= 0.16).

Conclusion
Despite HAART use, anaemia is still highly prevalent among HIV positive children in Lagos, Nigeria. With the known negative influence of anaemia on HIV disease progression, it is important that measures to address anaemia in these children are evaluated and implemented.