HIV (Human Immunodeficiency Virus) is the cause of acquired immunodeficiency syndrome (AIDS) as well as a large number of biological manifestations which can be responsible for serious haematological disorders affecting all blood lines including erythrocytes, explored by the blood count [1] [2].

Anemia remains one of the most common haematological complications in HIV infection in its AIDS phase [3]. It is defined by a decrease in hemoglobin level below 13 g/dl in men and 12 g/dl in women [4].

HIV infection is a growing problem of public health, but also of the society; true scourge of the 21st century [5].

In 2018, estimated 37.9 million people were living with HIV worldwide, of which 1.7 million were newly infected, 23.3 million were on antiretroviral therapy and 770,000 deaths from HIV/AIDS-related illnesses [6].

In Africa 25.7 million people were living with HIV, of which 1.3 million were on treatment, bringing the total number of people on antiretroviral therapy to 16.3 million, i.e. a coverage rate of 64% [7].

In Guinea 130,000 people were infected with HIV in 2014, and only 28,000 (21.54%) were on ARVs [8].

Hematologic abnormalities in general and anemia in particular in HIV occur in almost all patients as they progress. They are the result of the consequences of immunodeficiency and/or dysregulation of the immune system, complications of infections (bacterial, viral or fungal), side effects of multiple treatments and the direct role of the virus on certain hematopoietic progenitors and blood cells [5].

In the USA, Cosby of the University of California reported an 85% prevalence of anemia in 146 HIV-infected patients [9].

In Zimbabwe, Malyangu reports that during HIV infection, anemia is the most common cytopenia affecting 95.2% of people [10].

In SENEGAL in 2017, FALL S. et al., reported in their study anemia is in 83.3% [11].

The biological assessment is a real-time witness on the one hand of the efficacy and tolerance of the treatment and on the other hand of the évolution of the infection [12].

In September 2007, the Guinean state made antiretroviral treatment free for PLWHIV/AIDS. However, biological monitoring represents the weak point in the medical care of PLWHIV/AIDS under ARV treatment [13].

We therefore deemed it appropriate to assess the course of anemia at the start of ARV treatment while determining the factors that are likely to be associated.

The objective of this study was to describe the course of anemia in PLWHIV during the first 6 months of ART and to identify the associated factors in the Hematology Department of the Ignace Deen National Hospital.

A total of 45 patients with a median age of 36 years (interquartile range: 32.0 - 46.5 years) were included in this study; 29 (64.4%) were women. Thirty (66.7%) were singles, while the rest were married or widowed. The patients resided in Conakry in 82.2% of cases and consisted of civil servants (17.8%), liberal professions (75.6%), pupils and students (6.7%).

Anemia was confirmed in 40 (88.9%) patients, and it was severe in 28.9%. Clinically, the main reasons for consultation were prolonged fever (97.5%) and headache (26%). Of the anemic patients, 60% were in clinical stage I or II of AIDS according to WHO (Table 1, Table 2).

The patients were all infected with HIV1, on ARV treatment and the treatment regimen was, TDF-3TC-EFV (Tenofovir-Lamivudine-Efavirenz). Their outcomes were as follows: observant (82.5%), non-observant (2.5%), lost to follow-up (2.5%) and died (12.5) at M6.

Factors associated with anemia at the time of inclusion (Table 3) were opportunistic infections, WHO stage of AIDS and decreased CD4 count (P value).

The objective of this study was to describe the course of anemia in PLWHIV during the first 6 months of ARV treatment. It also aimed to analyze the factors associated with the occurrence of anemia in the Hematology Départment of the Ignace Deen National Hospital. The results showed that about nine out of ten people who were new to ARV treatment were anemic. In an earlier study carried out in Guinea [14], the authors had reported a relatively high frequency of anemia of around 54.6% in PLWHIV. This high frequency of anemia in our study could be explained by the fact that patients are diagnosed late with opportunistic conditions which lead for the most part to anemia regardless of the virus itself which could be another cause. This difference lies in the study population. Their study focused on patients being screened in wards that were not referral for anemia, while our populations were diagnosed in a Hematology Department on the occasion of a potentially anemic disease.

The frequency of anemia was significantly elevated in those with multiple opportunistic infections, advanced AIDS, and high viral load. In a study conducted in the DRC in 2014 [15], the results showed that the advanced clinical stage of the infection was a factor favoring anemia. These results confirm the fact that PLWHIV come to our department late but also the possibility, according to the literature, of haematological disturbances during this infection [5]. All of our anemic patients were infected with HIV 1 and the ARV treatment regimen was primarily TDF-3TC-EFV (Tenofovir-Lamuvidine-Efavirenz) to which the vast majority of patients were adherent.

We found that about a third of the patients presented with severe anemia. It was mainly normochromic normocytic anemia, the course of which was marked by a quasi-normalization of the mean hemoglobin level at the end of the six months of treatment. A study conducted in India [16] had reported predominance of normocytic normochromic anemia in PLWHIV. Another study conducted in Burkina had found a significant rise in hemoglobin levels [12]. Anemia with its signs of decompensation remains the reasons leading the patient to consult especially in a hematology service. This regression of anemia observed in our study could be explained by the quality of the patient care in the hematology service of the Ignace Deen Hospital but also the undoubtedly effectiveness of the ARV treatment and the treatments administered against opportunistic diseases.

This study could have some limitations. These are mainly the low sample size. However, the prospective nature of the study made it possible to collect quality data, the results of which will make it possible to formulate recommendations for improving the quality of patient care.

In conclusion, anemia is frequently associated with HIV infection linked to delayed treatment. Its development would be better with the establishment of good support. Specific actions should be taken to better identify the factors involved.

The authors contributed at one or more levels of the drafting of the manuscript from the protocol, the data collection, the drafting itself. They have all read and approved the final manuscript.

Our thanks to the place:

- Staff from the PLWHIV care unit of the hematology service of the Ignace Deen National Hospital of the CJU in Conakry;

- From the African Center of Excellence for the Prevention and Control of Communicable Diseases (CEA-PCMT);

- From the Guinea Infectious Disease Research and Training Center (CERFIG);

- From the Faculty of Health Sciences and Techniques of Gamal Abdel Nasser University in Conakry (FSTS/UGANC);

The authors declare no conflicts of interest regarding the publication of this paper.

Mamady, D., Sayon, K.A., Fatimata, K., Soumana, O., Toumin, C., Goudoussy, D.A., Mamadou, K., Mouctar, S., Fatou, C., Mohamed, A., Amara, T.F., Sidiki, M.A., Sidibé, S. and Touré, A. (2021) Contribution of ARV Treatment in the Correction of Anemia in People Living with HIV during the First Semester in the Hematology Department of Conakry University Hospital. World Journal of AIDS, 11, 143-151. https://doi.org/10.4236/wja.2021.114011