Erythrocyte indices, anaemia levels and types in Kenyan injection and non-injection substance users

Abstract

The impact
of injection and non-injection substance use in HIV infections is an area of
great public importance especially with respect to hematologic and immune
profiles. Evaluations of hematologic and immune status are critical for better
disease classification and clinical management especially of HIV positive substance
users. However, not much information is
known about the hematologic and immune derangements in HIV infected injection
and non-injection substance users. This study, therefore, aimed at determining
the laboratory markers of hematologic and immune derangements in HIV infected
substance users. Hematologic and immune
profiles were evaluated on venous blood specimens obtained from injection substance
users, ISU (HIV-infected, n=62 and -uninfected, n=213) and non-injection
substance users (HIV-infected, n=33 and -uninfected, n=186); and non-substance
using controls (n=56) from Mombasa, coastal town of Kenya. The prevalence of
anemia was higher in HIV infected ISU (48.4%) and non-ISU (63.6%) (p<0.0001);
and HIV uninfected ISUs (56.3%) compared to HIV-uninfected non-ISUs (39.2%) and
non-substance using controls (28.6%; p=0.0028).
Hypochromic anaemia was more prevalent in the HIV-infected ISU (50.0%)
and non-ISU (61.9%), and HIV-negative ISU (63.3%) relative to the HIV-negative
non-ISU (39.7%) and non-substance using controls (56.3%; p=0.0007). Mild
immunodeficiency dominated in the HIV infected individuals (HIV-infected ISU,
32.3% and non-ISU, 21.2%) versus HIV-uninfected ISU (16.9%); non-ISU (12.9%);
and non-substance users (14.3%) while severe immunosuppression prevailed in HIV
infected substance users (ISU, 14.5% and
non-ISU, 15.2%) against HIV uninfected substance users (ISU, 5.2% and non-ISU,
3.8%); thus immunosuppression in substance users is aggravated with HIV
infection. Moreover, drug-induced immunosuppression is associated with a higher
likelihood of anaemia in HIV-uninfected substance users; ISU (OR=3.95, CI=1.934-8.077,
p<0.0001) and non-ISU (OR=3.63, CI=1.571-8.39, p=0.003). Altogether, hypochromic anaemia, normochromic
anaemia and CD4+ T-helper cytopenia are the most prevalent hemocytopenias in
HIV infected and uninfected injection and non-injection substance users.