Hematological Abnormalities inAntiretroviral Therapy -Naïve HumanImmunodeficiency Virus-Infected Adultsfrom Southern India: Prevalence, Patternsand Their Relation to CD4 Count

Abstract

Background: Blood cell abnormalities are frequent in untreated human immunodeficiency virus (HIV) infection
and track closely with immune decline. Indian data on antiretroviral therapy (ART)-naïve patients are still thin.
We set out to document the prevalence and pattern of cytopenias in this group and test their association with CD4
count and WHO clinical stage. Methods: Forty ART-naïve HIV-positive adults attending a tertiary care center
between January and December 2023 were enrolled in a prospective observational study. Baseline complete
blood count (CBC), CD4 count, serum ferritin and vitamin B12 were recorded. Standard WHO thresholds defined
each cytopenia. Chi-square and Fisher’s exact tests assessed categorical associations. Multivariate logistic
regression adjusted for age, sex, nutritional status and the WHO stage identified independent predictors of severe
immunosuppression (CD4 <200 cells/mm3). Receiver operating characteristic (ROC) curve analysis examined
how well CBC parameters predicted CD4 <200 cells/mm3. Results: Mean age was 44.2 ± 9.6 years and 65% were
male. Sixty-five percent had CD4 <200 cells/mm3. Anemia was the most frequent finding at 90%, followed by
lymphopenia (75%), thrombocytopenia (57.5%), neutropenia (52.5%) and leucopenia (35%). Leucopenia (50.0%
vs. 7.1%; P = 0.007), neutropenia (76.9% vs. 7.1%; P < 0.001) and thrombocytopenia (84.6% vs. 7.1%; P < 0.001)
were significantly more common in patients with CD4 <200 cells/mm3. Neutropenia was also associated with the
advanced WHO stage (P = 0.005). On multivariate analysis, neutropenia (adjusted odds ratio [aOR] 9.64; 95%
confidence interval [CI] 1.85–50.3; P = 0.007), thrombocytopenia (aOR 11.25; 95% CI 2.04–61.9; P = 0.005)
and leucopenia (aOR 5.72; 95% CI 1.18–27.6; P = 0.030) each independently predicted CD4 <200 cells/mm3.
Neutrophil count gave AUC 0.86 (95% CI 0.74–0.98) and platelet count gave AUC 0.82 (95% CI 0.69–0.95)
on ROC analysis. Conclusion: Cytopenias are strikingly common among untreated HIV patients and worsen
with immune decline. Neutropenia and thrombocytopenia are independent predictors of CD4 <200 cells/mm3 and
could work as low-cost surrogate markers of disease severity where CD4 testing isn’t readily available.