Prevalence and associated factors of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia
Identifieur interne : 001377 ( Pmc/Corpus ); précédent : 001376; suivant : 001378Prevalence and associated factors of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia
Auteurs : Yitayih Wondimeneh ; Dagnachew Muluye ; Getachew FeredeSource :
- BMC Research Notes [ 1756-0500 ] ; 2014.
Abstract
Hematological abnormalities are common in HIV positive patients. Of these, thrombocytopenia is a known complication which has been associated with progression of disease. However, its magnitude and associated factors in HAART naive HIV positive patients is not known in Ethiopia. Therefore, the aim of this study was to determine the prevalence and associated factors of thrombocytopenia in HAART naïve HIV positive patients.
A retrospective study was carried out among HAART naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia, from September 2011 through August 2012. Socio-demographic variables and immunohematological (platelets and CD4+ T cells) values were carefully reviewed from medical records. Associated factors and outcomes were assessed using logistic regression.
A total of 390 HAART naive HIV positive patients with a mean age of 33.65 years and a range of 18–70 years were reviewed. The overall prevalence of thrombocytopenia was 23(5.9%). The mean CD4 count was 288 ± 188.2 cells/μL. HIV patients whose age ≥ 50 years old were 2.5 times more likely to have thrombocytopenia and those patients whose CD4 count < 350 were 2.6 times more likely to have thrombocytopenia than HIV patients whose CD4 count ≥500. However, CD4 count was not statistically associated with prevalence of thrombocytopenia (P > 0.05).
As CD4 counts of HIV patients decreasing, they have more likely to have thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.
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DOI: 10.1186/1756-0500-7-5
PubMed: 24387326
PubMed Central: 3916076
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence and associated factors of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia</title><author><name sortKey="Wondimeneh, Yitayih" sort="Wondimeneh, Yitayih" uniqKey="Wondimeneh Y" first="Yitayih" last="Wondimeneh">Yitayih Wondimeneh</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Muluye, Dagnachew" sort="Muluye, Dagnachew" uniqKey="Muluye D" first="Dagnachew" last="Muluye">Dagnachew Muluye</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Ferede, Getachew" sort="Ferede, Getachew" uniqKey="Ferede G" first="Getachew" last="Ferede">Getachew Ferede</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24387326</idno><idno type="pmc">3916076</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916076</idno><idno type="RBID">PMC:3916076</idno><idno type="doi">10.1186/1756-0500-7-5</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001377</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001377</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence and associated factors of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia</title><author><name sortKey="Wondimeneh, Yitayih" sort="Wondimeneh, Yitayih" uniqKey="Wondimeneh Y" first="Yitayih" last="Wondimeneh">Yitayih Wondimeneh</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Muluye, Dagnachew" sort="Muluye, Dagnachew" uniqKey="Muluye D" first="Dagnachew" last="Muluye">Dagnachew Muluye</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Ferede, Getachew" sort="Ferede, Getachew" uniqKey="Ferede G" first="Getachew" last="Ferede">Getachew Ferede</name><affiliation><nlm:aff id="I1">School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</nlm:aff></affiliation></author></analytic><series><title level="j">BMC Research Notes</title><idno type="eISSN">1756-0500</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Hematological abnormalities are common in HIV positive patients. Of these, thrombocytopenia is a known complication which has been associated with progression of disease. However, its magnitude and associated factors in HAART naive HIV positive patients is not known in Ethiopia. Therefore, the aim of this study was to determine the prevalence and associated factors of thrombocytopenia in HAART naïve HIV positive patients.</p></sec><sec><title>Methods</title><p>A retrospective study was carried out among HAART naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia, from September 2011 through August 2012. Socio-demographic variables and immunohematological (platelets and CD4+ T cells) values were carefully reviewed from medical records. Associated factors and outcomes were assessed using logistic regression.</p></sec><sec><title>Results</title><p>A total of 390 HAART naive HIV positive patients with a mean age of 33.65 years and a range of 18–70 years were reviewed. The overall prevalence of thrombocytopenia was 23(5.9%). The mean CD4 count was 288 ± 188.2 cells/μL. HIV patients whose age ≥ 50 years old were 2.5 times more likely to have thrombocytopenia and those patients whose CD4 count < 350 were 2.6 times more likely to have thrombocytopenia than HIV patients whose CD4 count ≥500. However, CD<sub>4</sub> count was not statistically associated with prevalence of thrombocytopenia (P > 0.05).</p></sec><sec><title>Conclusion</title><p>As CD4 counts of HIV patients decreasing, they have more likely to have thrombocytopenia. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Res Notes</journal-id><journal-id journal-id-type="iso-abbrev">BMC Res Notes</journal-id><journal-title-group><journal-title>BMC Research Notes</journal-title></journal-title-group><issn pub-type="epub">1756-0500</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24387326</article-id><article-id pub-id-type="pmc">3916076</article-id><article-id pub-id-type="publisher-id">1756-0500-7-5</article-id><article-id pub-id-type="doi">10.1186/1756-0500-7-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Prevalence and associated factors of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia</article-title></title-group><contrib-group><contrib contrib-type="author" id="A1"><name><surname>Wondimeneh</surname><given-names>Yitayih</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>yitayihlab@gmail.com</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Muluye</surname><given-names>Dagnachew</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>dagne24@gmail.com</email></contrib><contrib contrib-type="author" corresp="yes" id="A3"><name><surname>Ferede</surname><given-names>Getachew</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>get29f@gmail.com</email></contrib></contrib-group><aff id="I1"><label>1</label>School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia</aff><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>6</day><month>1</month><year>2014</year></pub-date><volume>7</volume><fpage>5</fpage><lpage>5</lpage><history><date date-type="received"><day>15</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>2</day><month>1</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 Wondimeneh et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2014</copyright-year><copyright-holder>Wondimeneh et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.biomedcentral.com/1756-0500/7/5"></self-uri><abstract><sec><title>Background</title><p>Hematological abnormalities are common in HIV positive patients. Of these, thrombocytopenia is a known complication which has been associated with progression of disease. However, its magnitude and associated factors in HAART naive HIV positive patients is not known in Ethiopia. Therefore, the aim of this study was to determine the prevalence and associated factors of thrombocytopenia in HAART naïve HIV positive patients.</p></sec><sec><title>Methods</title><p>A retrospective study was carried out among HAART naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia, from September 2011 through August 2012. Socio-demographic variables and immunohematological (platelets and CD4+ T cells) values were carefully reviewed from medical records. Associated factors and outcomes were assessed using logistic regression.</p></sec><sec><title>Results</title><p>A total of 390 HAART naive HIV positive patients with a mean age of 33.65 years and a range of 18–70 years were reviewed. The overall prevalence of thrombocytopenia was 23(5.9%). The mean CD4 count was 288 ± 188.2 cells/μL. HIV patients whose age ≥ 50 years old were 2.5 times more likely to have thrombocytopenia and those patients whose CD4 count < 350 were 2.6 times more likely to have thrombocytopenia than HIV patients whose CD4 count ≥500. However, CD<sub>4</sub> count was not statistically associated with prevalence of thrombocytopenia (P > 0.05).</p></sec><sec><title>Conclusion</title><p>As CD4 counts of HIV patients decreasing, they have more likely to have thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.</p></sec></abstract><kwd-group><kwd>Thrombocytopenia</kwd><kwd>HIV</kwd><kwd>HAART naive</kwd><kwd>CD4 count</kwd></kwd-group></article-meta></front><body><sec><title>Background</title><p>Human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function, which leads to the occurrence of opportunistic infections and tumors
[<xref ref-type="bibr" rid="B1">1</xref>]. Though the malfunction of the immune system and the decrease in the number and activity of CD4+ T cells signify the hallmark of HIV infection, it is notable that HIV can also impede with other cell lineages and tissues
[<xref ref-type="bibr" rid="B2">2</xref>,<xref ref-type="bibr" rid="B3">3</xref>]. In addition to progressive reduction of CD4+ T cells, peripheral blood cytopenias, such as anaemia, neutropenia and thrombocytopenia, happen in most patients with AIDS
[<xref ref-type="bibr" rid="B4">4</xref>,<xref ref-type="bibr" rid="B5">5</xref>].</p><p>Peripheral blood cytopenias have been showed even in the absence of chemotherapeutic treatment or opportunistic infections and tumours, signifying that HIV infection may be directly associated with the induction of these hematological abnormalities
[<xref ref-type="bibr" rid="B6">6</xref>]. Intriguingly, identified thrombocytopenia can signify the first clinical manifestation in otherwise asymptomatic HIV positive patients
[<xref ref-type="bibr" rid="B7">7</xref>] while neutropenia and anaemia are more common in the late stages of HIV disease
[<xref ref-type="bibr" rid="B8">8</xref>].</p><p>Thrombocytopenia is characterized by platelet counts below 125 × 10<sup>3</sup>/mm<sup>3</sup>, and also frequently occurs in HIV-infected patients
[<xref ref-type="bibr" rid="B9">9</xref>-<xref ref-type="bibr" rid="B11">11</xref>]. Its pathogenesis has not yet been recognized. Possible mechanisms that have been reported are increased platelet destruction, either caused by the non-specific deposition of circulating immune complexes on platelets or by the presence of specific anti-platelet antibodies, as well as direct infection of megakaryocytes by HIV with a resulting ineffective in platelet production
[<xref ref-type="bibr" rid="B12">12</xref>].</p><p>Incidence of thrombocytopenia is around 40% of HIV-infected persons, and in approximately 10% of the patients, it may be the first sign of AIDS
[<xref ref-type="bibr" rid="B13">13</xref>]. This haematological disorder may represent the first manifestation of HIV infection and it may progress over time and lead to severe bleeding
[<xref ref-type="bibr" rid="B14">14</xref>]. Mature Megakaryoctes (MKs) can be infected by HIV through binding the CD4 receptor
[<xref ref-type="bibr" rid="B15">15</xref>], and HIV genomes have been detected in MKs purified from bone marrow (BM) of HIV-positive patients
[<xref ref-type="bibr" rid="B16">16</xref>].</p><p>The infection of MKs is not strain-restricted because both R5- and X4-tropic HIV-1 strains are able to infect MKs thus indicating that the infection may occur early in the development of HIV infection
[<xref ref-type="bibr" rid="B17">17</xref>]. In addition to these direct effects of HIV on the MK cell lineage, HIV also supports chronic thrombocytopenia through autoimmune mechanisms
[<xref ref-type="bibr" rid="B14">14</xref>], particularly manifest in early stages of the disease
[<xref ref-type="bibr" rid="B18">18</xref>]. Autoimmune mechanisms are associated to anti-HIV antibodies cross-reacting with platelet-membrane glycoproteins, supporting the basic role of molecular mimicry in the induction of these antibodies
[<xref ref-type="bibr" rid="B19">19</xref>].</p><p>Thrombocytopenia is associated with increased morbidity and mortality, accelerated deterioration in CD4 counts and accelerated progression to AIDS
[<xref ref-type="bibr" rid="B20">20</xref>]. The incidence of thrombocytopenia varied according to the definition of thrombocytopenia and the characteristics of the baseline population
[<xref ref-type="bibr" rid="B21">21</xref>]. There is no such information for HIV-infected individuals in Ethiopia which may help to inform respective bodies for treatment of HIV-infected individuals in this area. We therefore assessed the prevalence of thrombocytopenia in HIV-infected HAART naive patients and also tried to determine the relationship between thrombocytopenia and CD4 cell counts in these patients.</p></sec><sec sec-type="methods"><title>Methods</title><p>A retrospective study was carried out among HAART naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia, from September 2011 through August 2012. Gondar University Hospital provides HIV/AIDS interventions including free diagnosis, treatment and monitoring. The center diagnoses new cases and monitors those on therapy. Patients on interferon therapy, chemotherapy, or malignancy were excluded.</p><p>Socio-demographic variables and immunohematological (platelets and CD4+ T cells) values were carefully reviewed retrospectively from medical records. Reviewed laboratory data of platelets analyses were done using the automated blood analyzer Cell-Dyn 1800 (Abott Laboratories Diagnostics Division, USA) and CD4 T lymphocyte counts were done using the Becton Dickinson FACS count. Thrombocytopenia was defined as platelets count <125.0 × 10<sup>3</sup>/mm
[<xref ref-type="bibr" rid="B22">22</xref>,<xref ref-type="bibr" rid="B23">23</xref>].</p><p>SPSS version 16 statistical software was used for analysis of the data. Descriptive statistics (minimum, maximum, mean and standard deviation) were used for continuous variables in the course of analysis and categorical data were analyzed using logistic regression. A P-value of < 0.05 was considered to be statistically significant.</p><p>Ethical clearance was obtained from the Institutional Ethical Review Board of University of Gondar and Permission for data collection was also obtained from the University Hospital.</p></sec><sec><title>Result</title><p>A total of 390 HAART naïve HIV positive patient results were reviewed from their medical records. Out of these, 271 (69.5%) were females. The mean age of the patients was 33.65 ± 9.1 years, ranging from 18–70 years. The majority of study participants 328 (84.1%) were urban residents (Table
<xref ref-type="table" rid="T1">1</xref>).</p><table-wrap position="float" id="T1"><label>Table 1</label><caption><p>Socio-demographic characteristics of HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia, 2013</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="top"><tr><th align="left"><bold>Variables</bold></th><th align="left"><bold>Frequency</bold></th><th align="left"><bold>Percentage (%)</bold></th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom"><bold>Sex</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Male<hr></hr></td><td align="left" valign="bottom">119<hr></hr></td><td align="left" valign="bottom">30.5<hr></hr></td></tr><tr><td align="left" valign="bottom">Female<hr></hr></td><td align="left" valign="bottom">271<hr></hr></td><td align="left" valign="bottom">69.5<hr></hr></td></tr><tr><td align="left" valign="bottom"><bold>Age in years</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">18-29<hr></hr></td><td align="left" valign="bottom">125<hr></hr></td><td align="left" valign="bottom">32.1<hr></hr></td></tr><tr><td align="left" valign="bottom">30-39<hr></hr></td><td align="left" valign="bottom">165<hr></hr></td><td align="left" valign="bottom">42.3<hr></hr></td></tr><tr><td align="left" valign="bottom">40-49<hr></hr></td><td align="left" valign="bottom">74<hr></hr></td><td align="left" valign="bottom">19<hr></hr></td></tr><tr><td align="left" valign="bottom">50 & above<hr></hr></td><td align="left" valign="bottom">26<hr></hr></td><td align="left" valign="bottom">6.7<hr></hr></td></tr><tr><td align="left" valign="bottom"><bold>Residence</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Urban<hr></hr></td><td align="left" valign="bottom">328<hr></hr></td><td align="left" valign="bottom">84.1<hr></hr></td></tr><tr><td align="left" valign="bottom">Rural<hr></hr></td><td align="left" valign="bottom">62<hr></hr></td><td align="left" valign="bottom">15.9<hr></hr></td></tr><tr><td align="left" valign="bottom"><bold>Religion</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Christian<hr></hr></td><td align="left" valign="bottom">358<hr></hr></td><td align="left" valign="bottom">91.8<hr></hr></td></tr><tr><td align="left" valign="bottom">Muslim<hr></hr></td><td align="left" valign="bottom">30<hr></hr></td><td align="left" valign="bottom">7.7<hr></hr></td></tr><tr><td align="left">Others</td><td align="left">2</td><td align="left">0.5</td></tr></tbody></table></table-wrap><p>The overall prevalence of thrombocytopenia was 23(5.9%). Platelet levels of the study participants were between 29×10<sup>3</sup> cells/μl and 653×10<sup>3</sup> cells/μl with the mean of 258×10<sup>3</sup> ± 100.561 cells/μl. The minimum CD4 count was 9 cells/μL, and the maximum was 1280 cells/μL. The mean CD4 count was 288 ± 188.2 cells/μL. In this study, majority of the thrombocytopenia cases 12 (7.3%) were observed in the age group of 30–39 years. However, the difference was not statistically significant. HIV patients whose age ≥ 50 years old were 2.5 times more likely to have thrombocytopenia and those patients whose CD4 counts < 350 were 2.6 times more likely to have thrombocytopenia than HIV patients whose CD4 count ≥500 (Tables
<xref ref-type="table" rid="T2">2</xref> and
<xref ref-type="table" rid="T3">3</xref>).</p><table-wrap position="float" id="T2"><label>Table 2</label><caption><p>Prevalence of thrombocytopenia among HAART naive HIV positive patients at Gondar university hospital, northwest Ethiopia, 2013</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="top"><tr><th align="left"><bold>Platelet count</bold></th><th align="left"><bold>Frequency</bold></th><th align="left"><bold>Percentage (%)</bold></th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom">≥125.0 × 10<sup>3</sup>/mm<hr></hr></td><td align="left" valign="bottom">367<hr></hr></td><td align="left" valign="bottom">94.1<hr></hr></td></tr><tr><td align="left" valign="bottom"><125.0 × 10<sup>3</sup>/mm<hr></hr></td><td align="left" valign="bottom">23<hr></hr></td><td align="left" valign="bottom">5.9<hr></hr></td></tr><tr><td align="left">Total</td><td align="left">390</td><td align="left">100</td></tr></tbody></table></table-wrap><table-wrap position="float" id="T3"><label>Table 3</label><caption><p>Association of thrombocytopenia with related factors among HAART naïve HIV positive patients at Gondar university hospital, northwest Ethiopia, 2013</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="top"><tr><th align="left" valign="bottom"><bold>Variables</bold><hr></hr></th><th align="right" valign="bottom"><bold>Thrombocytopenia</bold><hr></hr></th><th align="left" valign="bottom"> <hr></hr></th><th align="right" valign="bottom"><bold>OR (95% CI)</bold><hr></hr></th><th align="left" valign="bottom"> <hr></hr></th><th align="left" valign="bottom"><bold>P- value</bold><hr></hr></th></tr><tr><th align="left"> </th><th align="left"><bold>Yes (%)</bold></th><th align="left"><bold>No (%)</bold></th><th align="left"><bold>Crude</bold></th><th align="left"><bold>Adjusted</bold></th><th align="left"> </th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom"><bold>Sex</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom">0.49<hr></hr></td></tr><tr><td align="left" valign="bottom">Male<hr></hr></td><td align="left" valign="bottom">9(7.6)<hr></hr></td><td align="left" valign="bottom">110(92.4)<hr></hr></td><td align="left" valign="bottom">1<hr></hr></td><td align="left" valign="bottom">1<hr></hr></td><td rowspan="2" align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Female<hr></hr></td><td align="left" valign="bottom">14(5.2)<hr></hr></td><td align="left" valign="bottom">257(94.8)<hr></hr></td><td align="left" valign="bottom">0.7(0.28-1.58)<hr></hr></td><td align="left" valign="bottom">0.7(0.30-1.79)<hr></hr></td></tr><tr><td align="left" valign="bottom"><bold>Age</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom">0.46<hr></hr></td></tr><tr><td align="left" valign="bottom">18-29<hr></hr></td><td align="left" valign="bottom">5(4)<hr></hr></td><td align="left" valign="bottom">120(96)<hr></hr></td><td align="left" valign="bottom">1<hr></hr></td><td align="left" valign="bottom">1<hr></hr></td><td rowspan="4" align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">30-39<hr></hr></td><td align="left" valign="bottom">12(7.3)<hr></hr></td><td align="left" valign="bottom">153(92.7)<hr></hr></td><td align="left" valign="bottom">1.9(0.65-5-49)<hr></hr></td><td align="left" valign="bottom">1.7(0.57-5.06)<hr></hr></td></tr><tr><td align="left" valign="bottom">40-49<hr></hr></td><td align="left" valign="bottom">3(4.1)<hr></hr></td><td align="left" valign="bottom">71(95.9)<hr></hr></td><td align="left" valign="bottom">1.0(0.24-4.37)<hr></hr></td><td align="left" valign="bottom">0.8(0.19-3.81)<hr></hr></td></tr><tr><td align="left" valign="bottom">≥50<hr></hr></td><td align="left" valign="bottom">3(11.5)<hr></hr></td><td align="left" valign="bottom">23(88.5)<hr></hr></td><td align="left" valign="bottom">3.1(0.70-14.02)<hr></hr></td><td align="left" valign="bottom">2.5(0.54-11.66)<hr></hr></td></tr><tr><td align="left" valign="bottom"><bold>CD4 count</bold><hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom">0.57<hr></hr></td></tr><tr><td align="left" valign="bottom"><350<hr></hr></td><td align="left" valign="bottom">19(6.8)<hr></hr></td><td align="left" valign="bottom">260(93.2)<hr></hr></td><td align="left" valign="bottom">3.14(0.41-24.08)<hr></hr></td><td align="left" valign="bottom">2.6(0.33-20.61)<hr></hr></td><td rowspan="2" align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">350-499<hr></hr></td><td align="left" valign="bottom">3(4.5)<hr></hr></td><td align="left" valign="bottom">64(95.5)<hr></hr></td><td align="left" valign="bottom">2.02(0.20-20.02)<hr></hr></td><td align="left" valign="bottom">1.8(0.17-17.89)<hr></hr></td></tr><tr><td align="left">≥500</td><td align="left">1(2.3)</td><td align="left">43(97.7)</td><td align="left">1</td><td align="left">1</td><td align="left"> </td></tr></tbody></table><table-wrap-foot><p>Note: 1- reference group.</p></table-wrap-foot></table-wrap></sec><sec sec-type="discussion"><title>Discussion</title><p>Increasing the intricacy of HIV infection, varied hematological manifestations can be seen, in which HIV related thrombocytopenia is one of them
[<xref ref-type="bibr" rid="B24">24</xref>]. We assessed platelet counts in HAART naive HIV infected patients, which showed that 5.9% of the sample population had thrombocytopenia, which was in agreement with previous studies by Denue <italic>et al</italic>.,
[<xref ref-type="bibr" rid="B25">25</xref>], Sloand <italic>et al</italic>.,
[<xref ref-type="bibr" rid="B21">21</xref>], Sullivan <italic>et al.,</italic>[<xref ref-type="bibr" rid="B26">26</xref>], and Suresh <italic>et al</italic>.,
[<xref ref-type="bibr" rid="B27">27</xref>]. However, lower than reported by Erhabor <italic>et al.,</italic>[<xref ref-type="bibr" rid="B28">28</xref>] and Akinsegun <italic>et al</italic>.,
[<xref ref-type="bibr" rid="B29">29</xref>]. This problem is truly a medical challenge in vulnerable population, especially by the limited therapeutic options and the absence of intervention protocol for HIV subjects
[<xref ref-type="bibr" rid="B9">9</xref>].</p><p>Results from this study showed that majority of HAART-naïve HIV positive patients were females. The female prevalence in this study confirms the World Health Organization (WHO) report that HIV/AIDS affects females most severely in sub-Saharan Africa
[<xref ref-type="bibr" rid="B30">30</xref>,<xref ref-type="bibr" rid="B31">31</xref>]. However, thrombocytopenia had not showed statistical significance with sex and age (p > 0.05). This was in agreement with previous study done by Majluf-Cruz
[<xref ref-type="bibr" rid="B24">24</xref>].</p><p>According to the present study, as immunity of a patient decreasing, thrombocytopenia was more prevalent rather than HIV positive patients who have relatively high CD4 count. For example, the prevalence of thrombocytopenia was proportionally high among patients who had a CD4 lymphocyte count of ≤ 350 cells/μL and low among patients with a CD4 count > 500 cells/μL. However, the increase in prevalence of thrombocytopenia with decreased CD4 cell count was not statistically significant (P >0.05). Similar findings have been reported by Elisaphane <italic>et al.,</italic>[<xref ref-type="bibr" rid="B32">32</xref>], Ira and Bhushan
[<xref ref-type="bibr" rid="B33">33</xref>].</p><p>To the best of our knowledge, this is the first study in Ethiopia to determine prevalence of thrombocytopenia in HAART-naïve HIV infected patients. However, this study had limitations such as its retrospective nature which introduces possible biases related to ascertainment, documentation and chart review. In addition, this study was not included HIV infected patients who had on HAART. However, the observed results may still be a good reflection of a true circumstances and this study serve as a reference for additional recommendations to improve care of HIV infected persons and a step for further studies on the pathophysiology of HIV associated thrombocytopenia.</p></sec><sec sec-type="conclusions"><title>Conclusion</title><p>In conclusion, as CD4 counts of HIV patients decreasing, they have more likely to have thrombocytopenia. Based on this finding, it is recommended that physicians giving care for HIV infected individuals should routinely investigate and treat thrombocytopenia.</p></sec><sec><title>Competing interests</title><p>The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.</p></sec><sec><title>Authors’ contributions</title><p>YW: Participated in the conception and design of the study, data collection, analysis and interpretations of the findings, reviewed the manuscript. DM: Participated in the conception and design of the study, analysis and interpretations of the findings, reviewed the manuscript. GF: Participated in the conception and design of the study, data collection, analysis and interpretations of the findings, drafting the manuscript and write up. 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