RI

FTVALLEYUNI
VERSI
TY

DEPARTMENTOFMEDI
CALLABORATORYSCI
ENCE

ASSESSMENT OF HEMATOLOGI
CAL PROFI
LES AMONG HI
V POSI
TIVE
PATI
ENTSATBI
SHOFTU GENERALHOSPI
TALBETWEEN,MAYAND JULY
2021

Thethesi
ssubmitt
edtoRi
ftVal
leyUni
versit
y,Facult
yofHeal
thandMedi
cal
Sci
ences,Depar
tmentofMedi
calLaborator
ySci encesi
nful
fi
ll
mentoft
he

a
r
equi
rement
sofBachel
orofSci
enceDegr
eei
nMedi
cal
Labor
ator
ySci
ences

Jul
y,2021GC

Adama,
Oromi
a.

ASSESSMENT OF HEMATOLOGI
CAL PROFI
LES AMONG HI
V POSI
TIVE
PATI
ENTS AT BI
SHOFTU GENERALHOSPI
TALBETWEEN MAY 2020AND
JULY2021

BY:

1.ALEMTSHEHAYSI
MA…….
………….
.….
0012/
16

2.ALEMNESHBEI
MNET.
……………….
…..
0048/
16

3.BI
ZUNEHMULUGETA……………………0033/
16

4.GEDUHI
RPHAYE………………….
.………0034/
16

5.BETELALEMAYEW ……………….
.…….
.0032/
16

6.TADESSEGAME……………….
.…….
…….
0019/
16

7.MEDI
NAHAMI
DO……………….
.…………0050/
16

b
ADVI
SOR:
GIRMAMULI
SA(
PHDCANDI
DATE,
ASSO,
PROFFESSOR)

Jul
y,2021GC

Adama,
Oromi
a

Ri
ftVal
l
eyUni
ver
sit
y

1.Al
emt
hehaySi
ma

2.Al
emneshBei
mnet

3.Bi
zuneMul
uget
a
Nameoft
hei
nvest
igat
ors
4.GeduHi
rpay
e

5.Bet
elAl
emay
ew

6.TaddesseGeme

7.Medi
naHemi
do

NameofAdv
isor Gi
rmaMul
i
sa(
PHDcandi
dat
eAsso,
Prof
essor
)

c
Ti
tt
le of t
he Resear
ch AssessmentofHemat
ologi
calpr
ofi
l
esAmong HI
V posi
ti
ve

pr
oject Pat
ient
s

Dur
ati
onoft
hepr
oject Fr
om Mayt
oJul
y,
2021

St
udyAr
ea EastShewa,
Bishof
tuTown,
Bishof
tuHospi
tal

d
 Tabl
eofCont
ent
s

Tabl
eofCont
ent
s I
11.Acknowl
edgement I
II
Li
stsofTabl
esandFi
gur
es I
V
Acr
ony
msandAbbr
evi
ati
ons V
Abst
ract VI
I
ntr
oduct
ion 1
1.
Backgr
ound 1
1.
2St
atementofpr
obl
em 3
1.
3Resear
chQuest
ions 5
2.
Lit
erat
urer
evi
ew 6
3.
Hypot
hesi
s 8
3.
1TheNul
lhy
pot
hesi
s(HO) 8
4.
Obj
ect
ives 9
4.
1Gener
alobj
ect
ive 9
4.
2Speci
fi
cobj
ect
ives 9
5.
Mat
eri
alsandMet
hods 10
5.
1St
udyar
ea 10
5.
2St
udyper
iod 10
5.
3St
udydesi
gn 10
5.
4Sour
cepopul
ati
on 10
5.
5St
udypopul
ati
on 10
5.
5Sampl
esi
zedet
ermi
nat
ion 11
5.
6Sampl
i
ngt
echni
que 11
5.
7Sel
ect
ioncr
it
eri
a 11
5.
8St
udyv
ari
abl
es 12
5.
8.1Dependentv
ari
abl
es 12
5.
8.2I
ndependentv
ari
abl
es 12
5.
9Oper
ati
onal
def
ini
ti
on 12

I
 5.
10.Dat
acol
l
ect
iont
ool
andt
estpr
ocedur
es 12
5.
10.
1Dat
acol
l
ect
ioni
nst
rument
s 12
5.
10.
2Dat
acol
l
ect
ionpr
ocedur
e 13
5.
11 Bl
oodspeci
mencol
l
ect
ion
13
5.
12 Reagent
susedf
orHemat
ologyanal
ysi
sandCD4count 13
5.
13 Dat
aqual
i
tycont
rol 13
5.
14 Dat
apr
ocessi
ngandanal
ysi
s 14
5.
15 Et
hical
consi
der
ati
on 14
5.
16 Pl
anf
ordi
ssemi
nat
ionoff
indi
ngs 14
6.
Resul
t 15
6.
1Soci
o-demogr
aphi
cchar
act
eri
sti
cs 15
6.
2.I
mmunol
ogi
cal
par
amet
ers 17
6.
3Hemat
ologi
cal
Val
uesbef
oreandaf
teri
nit
iat
ionofART 17
6.
4Pr
eval
enceofi
mmunohemat
ologi
cal
abnor
mal
i
ties 19
7.Di
scussi
on 21
8.Concl
usi
on 23
9.Li
mit
ati
onoft
hest
udy 24
10.Recommendat
ions 25
12.Ref
erence 26
13.Annexes 28
13.
1Inf
ormat
ionsheet 28
13.
2ConsentFor
m. 30

I
I
 11.Acknowl
edgement
 We wi
sh t
o expr
ess oursi
ncer
ethanks t
othe Adama Ri
ftVal
l
eyLabor
ator
y
Depar
tment
,forpr
ovi
dinguswi
tht
heal
lnecessar
ymat
eri
al.

 Wewoul
dli
ket
oexpr
essourhear
tfel
tgr
ati
tudet
oouradv
isor
,TeacherGi
rma
Mul
i
saa,f
orhi
sini
ti
ati
on,encour
agementandconst
ruct
iveadv
icet
hroughoutst
udy
t
hatar
ehel
pful
forr
eal
i
zat
ionoft
hist
hesi
s

 Ourdeepestgr
ati
tudeal
sogoest
oal
lst
affofARTCl
i
nicuni
tofBi
shof
tuGener
al
Hospi
talf
orpr
ovi
dinguswi
tht
henecessar
yinf
ormat
ionandf
aci
l
itat
ingcondi
ti
ons
whi
l
ewecar
ryi
ngoutt
hisst
udy
.

 We woul
dli
ke t
o expr
essourdeep gr
ati
tude t
o Bi
shof
tu Gener
alHospi
talf
or
per
mit
ti
ngandf
aci
l
itat
ingpr
econdi
ti
ont
oper
for
m ourt
asks.

 Wewoul
dal
sol
i
ket
othankal
lst
aff
sofl
abor
ator
yfort
hei
rshar
edt
hei
rknowl
edge,
exper
ienceandpr
ofessi
onal
suppor
tdur
ingourst
udy
.

 Ourgr
atef
ult
hanksal
soex
tendedt
oseni
orLabor
ator
yTechnol
ogi
stFi
kruYadet
a
whoshar
edushi
sexper
ienceandknowl
edgeonev
eryt
it
tl
esandcont
ent
s.

 Wewoul
dal
sol
i
ket
othanksal
lthet
eam oft
hisst
udyf
ort
hei
ract
ivepar
ti
cipat
ion
andcommi
tment
s.

 Abov
eal
l
,wet
hankGodf
orgi
vi
ngust
heabi
l
ity
,heal
thandwel
l
-bei
ngt
hatwer
e
necessar
ytost
artandcompl
etet
het
hesi
s.

I
II
 Li
stsofTabl
esandFi
gur
es

Tabl
e1:Wor
kpl
anofr
esear
chconduct
edatBi
shof
tuGener
alHospi
talf
rom May2021t
o
Jul
…..
.11

Tabl
e2.Costest
imat
efort
heact
ivi
tyoft
hest
udyonBi
shof
tuGener
alf
rom May1,
2021t
o
Jul
y 30,
2021………………………………………………………………………………….
…12

Tabl
e 3:Soci
o-demogr
aphi
c char
act
eri
sti
cs ofHI
V posi
ti
vei
ndi
vi
dual
staki
ng ART at
Bi
shof
tuHospi
tal
ARTuni
tin2021……………………………………………………………….
..
13

Tabl
e4:I
mmunohemat
ologi
calv
alues(
Mean±SD)ofHI
V posi
ti
veadul
tindi
vi
dual
sat
basel
i
neandaf
ter6mont
hsofARTatBi
shof
tuHospi
talARTuni
t,Bi
shof
tu,
Oromi
a,
2021…………………………………………………………………………….
.………….
16

Fi
gur
e1:Meanv
aluesofCD4countamongHI
Vposi
ti
veadul
tindi
vi
dual
staki
ngARTatt
he
basel
i
neandaf
ter6mont
hsofARTatBi
shof
tuGener
alHospi
talARTuni
t,Bi
shof
tu,
Or
omi
a,………………………………………………………………………………2021.
.15

Fi
gur
e2:Pr
eval
enceofHemat
ologi
calabnor
mal
i
tiesandi
tsper
cent
ageofHI
VPosi
ti
ve
i
ndi
vi
dual
satbasel
i
neandaf
ter6mont
hsofARTatBi
shof
tuGener
alHospi
tal
,ART

I
V
 uni
t,Bi
shof
tu,
Oromi
a………………………………………………………………………………….
…..
17

Fi
gur
e 3.
Compar
isonof
thesev
eri
tyof
anemi
aandi
tsper
cent
ageof
HIVposi
ti
veadul
tanemi
c
subj
ect
satbasel
i
neandaf
ter6mont
hsofHAARTatBl
i
shof
tuHospi
taHospi
tal
ARTuni
t,
Bishof
tu,
Oromi
a,2021………………………………………………………….
.……………….
.….
18

Acr
ony
msandAbbr
evi
ati
ons
AI
DS……Acqui
redI
mmunodef
ici
encySy
ndr
ome

ANC…….
Absol
uteNeut
rophi
lCount

ART…….
.Ant
iRet
rov
iral
ther
apy

CBC.
..
..
….Compl
eteBl
oodCel
l

CD4…….
..
Clust
erofDi
ff
erent
iat
ion4

CD8…….
.Cl
ust
erofDi
ff
erent
iat
ion8

Di
ff
……….
Dif
fer
ent
ial

V
DNA…….
..
Deoxy
ribonucl
eicAci
d

EDTA…….Et
hyl
eneDi
ami
neTet
raacet
icACI
D

GRI
D….
..
..
GayRel
atedI
mmunodef
ici
encyDi
sease

HAART.
.…Hi
ghl
yAct
iveAnt
iRet
roTher
apy

HA….
..
..
..
..
Alt
ernat
iveHy
pot
hesi
s

HGB….
..
…Hemogl
obi
n

HI
V….
…..
.HumanI
mmunodef
ici
encyVi
rus

HO…….
….Nul
lHy
pot
hesi
s

MCH…….
.MeanCor
puscul
arHemogl
obi
n

MCHC.
…..
MeanCor
puscul
arHemogl
obi
nConcent
rat
ion

MCV….
…MeanCor
puscul
arVol
ume

PCV….
..
..
..PackedCel
lVol
ume

PLT…….
….Pl
atel
et

PLWHA…Peopl
eli
vewi
thHI
VAI
DS

RBC…….
.RedBl
oodCel
l

RDW….
…RedBl
oodCel
lDi
str
ibut
ionWi
dth

SD……….
Standar
dDev
iat
ion

SPSS…….
Stat
ist
ical
Packagef
ort
heSoci
alSci
ence.

TB….
…..
.Tuber
cul
osi
sBaci
l
li

T.
CELL.
..Thy
musHel
perCel
l

TLC….
…Tot
all
eukocy
teCount

WBC….
..
Whi
teBl
oodCel
l

VI
WHO….Wor
ldHeal
thOr
gani
zat
ion

Abst
ract
1.Backgr
ound፡

HI
Vinf
ect
ion br
ings hemat
ologi
calchanges t
hatcompl
i
cat
e heal
th and t
reat
mentof
pat
ient
swhi
chi
sdi
ver
seandmaycausesy
mpt
omst
hatar
eli
fet
hreat
eni
ngandi
mpai
rthe
qual
i
tyofl
i
fe.
itmayal
sohi
ndert
her
apyt
owar
dspr
imar
yinf
ect
ion,
oppor
tuni
sti
cinf
ect
ions.
I
fiti
snotcont
rol
l
edbyt
reat
ment
,thel
ossofCD4cel
l
sleadst
othedev
elopmentofser
ious
i
l
lnesses,
or‘
oppor
tuni
sti
cinf
ect
ions’
anddeat
h.

2.Obj
ect
ive:

Thest
udywasunder
takent
oasseshemat
ologi
calpr
ofi
l
esamongHI
Vposi
ti
vei
ndi
vi
dual
s
t
aki
ngAnt
ir
etr
ovi
ral
Ther
apy(
ART)atBi
shof
tuHospi
tal
,Bi
shof
tu,
Oromi
a.

3.Met
hods:

Acr
oss-
sect
ionalst
udywasconduct
edf
rom Mayt
oJul
y,2022on136HI
Vposi
ti
ve
i
ndi
vi
dual
swhohav
ebeent
aki
ngARTf
ormor
ethansi
xmont
hsdat
awascol
l
ect
edby
usi
ngst
ruct
uredquest
ionnai
ret
hati
ncl
udedv
ari
abl
esr
elat
edt
osoci
o-demogr
aphi
c
char
act
eri
sti
cs and cl
i
nicalcondi
ti
ons oft
he st
udyi
ndi
vi
dual
s.Measur
ement
s of
compl
etebl
oodcel
lcountandCD4+Tcel
lcount
swer
emade.

4.Resul
ts:

Ther
ewassi
gni
fi
canti
ncr
easei
nthemeanv
aluesofCD4count(
162.
5vs347cel
l
s/µl
,WBC
count(
5.52v 19×103/
s6. µl,neut
rophi
l(2.
99v 25×103/
s3. µl,l
ymphocy
te(
1.85v 44×103/
s3. µl,
hemogl
obi
n(12.
8vs14.
34g/
dl,al
lRBCi
ndi
cesandpl
atel
ets( s273×103/
223v µl.Ther
ewas
al
sosi
gni
fi
cantdecr
easei
nthepr
eval
enceofanemi
a(41.
9vs11.
4%,p-
<0.
001)
,leucopeni
a
(
26.
7vs16.
5%,p<0.
001)
,neut
ropeni
a(16.
5vs9.
4%,p<0.
05)
,ly
mphopeni
a(20v
s3.
1%,
p<0.
001)andt
hrombocy
topeni
a(25.
9vs7.
1,p<0.
001)af
tersi
xmont
hsofARTcompar
edt
o
t
hebasel
i
ne.

5.Concl
usi
on:

I
tisev
identf
rom t
hisst
udyt
hatt
hepar
ti
cipant
shav
eshownsi
gni
fi
canti
mpr
ovement
sin

VI
I
hemat
ologi
calpr
ofi
l
esaf
tert
aki
ngantr
etr
ovi
ralt
reat
ment
.Fur
theri
nvest
igat
ionshowev
er
necessar
ytoassesshemat
ologi
cal
prof
il
esi
nHI
Vpat
ient
s.

Key
wor
ds:
ART,
hemat
ologi
cal
par
amet
ers,
hemat
ologi
cal
abnor
mal
i
ties.

VI
II
 I
ntr
oduct
ion
1.Backgr
ound
Thef
ir
stcaseofAcqui
redI
mmunodef
ici
encySy
ndr
ome(
AIDS)wer
erepor
tedi
nUni
ted
St
atesi
nthe1981andby1983,t
hehumani
mmunodef
ici
encyv
irus(
HIV)t
hev
irust
hat
causesAI
DS,hadbeeni
dent
if
ied.Butasar
ecentmanyt
heor
iesi
ndi
cat
esaboutt
heor
igi
n
ofHI
V,t
hemostl
i
kel
yexpl
anat
ioni
sthatHI
Vwasi
ntr
oducedt
ohumanf
rom monkey
sor
subspeci
esofchi
mpanzeesnat
ivet
owestequat
ori
alAf
ri
ca(
1).

Thedi
seasei
sini
ti
all
y(i
n1981)cal
l
edGay
-Rel
atedI
mmuneDef
ici
ency(
GRI
D)becausei
tis
t
houghti
tonl
yaf
fect
sgaymen.Lat
err
enamedasAcqui
redI
mmuneDef
ici
encySy
ndr
ome
(
AIDS)i
n1982af
terwomencanal
sobei
nfect
edt
hroughhet
erosexual
sex(
2)

Ther
ear
etwot
ypesofHI
V,HI
V-1andHI
V-2.HI
V-1i
smor
evi
rul
ent
,easi
l
ytr
ansmi
tt
edand
i
sthecauseoft
hev
astmaj
ori
tyofHI
Vinf
ect
ionsgl
obal
l
y.Thepandemi
cst
rai
nofHI
V-1i
s
cl
osel
yrel
atedt
oav
irusf
oundi
nchi
mpanzees,whi
chl
i
vei
nthef
orest
soft
heCent
ral
wher
easHI
V-2i
slesst
ransmi
tt
abl
eandi
slar
gel
yconf
inedt
oWestAf
ri
ca(
3).

HI
V/AI
DShasf
ourhi
erar
chi
calcl
i
nicalst
ageswhi
char
e:St
age1,asy
mpt
omat
icst
ageor
hav
eper
sist
entgener
ali
zedl
ymphadenopat
hy.St
age2,
mil
dlysy
mpt
omat
icst
age,
Stage3,
t
he moder
atel
y sy
mpt
omat
ic st
age and St
age 4,t
he sev
erel
y sy
mpt
omat
ic st
age)
desi
gnat
ioni
ncl
udesal
loft
heAI
DS-
def
ini
ngi
l
lnesses(
4).

HI
Vvi
rusi
str
ansmi
tt
edt
hroughbodi
l
yfl
uidssuchasbl
ood,semen,v
agi
nalf
lui
ds,anal
f
lui
ds,andbr
eastmi
l
kandi
thasmostof
tenbeenspr
eadt
hroughunpr
otect
edsex,t
he
shar
ingofcommonshar
pmat
eri
alf
ordr
uguse,
andt
hroughbi
rt
h.I
twor
ksbyat
tacki
ngt
he
humani
mmunesy
stem andcannotr
epl
i
cat
eoni
tsown,
soi
nor
dert
omakenewcopi
esof
i
tsel
f,i
tmusti
nfectcel
l
soft
hehumani
mmunesy
stem,
cal
l
edCD4cel
l
s(3,
5,6)
.

1
HI
Vinf
ect
sat
ypeofwhi
tebl
oodcel
lint
hebody
’si
mmunesy
stem cal
l
edaT-
hel
percel
l
(
alsocal
l
edaCD4cel
l
)byat
tachesi
tsel
ftoaT-
hel
percel
landf
useswi
thi
t(j
oinst
oget
her
).
I
ttakescont
roloft
hecel
l
’sDNA,
makescopi
esofi
tsel
finsi
det
hecel
l
,andf
inal
l
yrel
eases
mor
eHI
Vint
othebl
ood.I
tweakenst
hebody
’snat
uraldef
ensesandov
ert
imesev
erel
y
damagest
hei
mmunesy
stem andki
l
lst
heCD4cel
l
sthebody
’sabi
l
ityt
orecogni
zeand
f
ightsomet
ypesofi
nfect
ionbegi
nst
odecl
i
ne(
6,7)
.

HI
Vinf
ect
ion br
ings hemat
ologi
calchanges t
hatcompl
i
cat
e heal
th and t
reat
mentof
pat
ient
swhi
chi
sdi
ver
seandmaycausesy
mpt
omst
hatar
eli
fet
hreat
eni
ngandi
mpai
rthe
qual
i
tyofl
i
fe.
itmayal
sohi
ndert
her
apyt
owar
dspr
imar
yinf
ect
ion,
oppor
tuni
sti
cinf
ect
ions.
I
fiti
snotcont
rol
l
edbyt
reat
ment
,thel
ossofCD4cel
l
sleadst
othedev
elopmentofser
ious
i
l
lnesses,or‘
oppor
tuni
sti
cinf
ect
ions’anddeat
h.Hemat
ologi
calpar
amet
ersar
eimpor
tant
moni
tor
ingt
ool
sforassessi
ngt
reat
mentandpr
ognosi
sinHI
V.Hencei
tisi
mpor
tantt
o
det
ermi
net
heexactandext
entofhemat
ologi
calchangesi
nHI
Vpat
ient
swhi
chwi
l
lleadt
o
ahol
i
sti
ctr
eat
mentandi
mpr
ovequal
i
tyofl
i
feoft
hesepat
ient(
6,7,
8)

Hemat
ologi
cal
abnor
mal
i
tiesar
ecommoncompl
i
cat
ionsofhumani
mmunodef
ici
encyv
irus
i
nfect
ion.Theseabnor
mal
i
tiesi
ncr
easeast
hedi
seaseadv
ancesi
nbot
hant
ir
etr
ovi
ral
-
t
reat
ed and unt
reat
ed i
ndi
vi
dual
s,di
ff
erentt
ypes ofhemat
ologi
calabnor
mal
i
ties ar
e
common(
8,9)
.

Thesechangesi
ncl
udedepl
eti
on i
n CD4+ T cel
l
,cy
toki
nedy
sregul
ati
on and i
mmune
dy
sfunct
ion.Thechangesoccurmai
nlyduet
osev
eralf
act
orssuchasmar
rowdef
ect
sand
i
mmunecy
topeni
ascausedbyei
therdi
rect
lyt
othebonemar
row,oppor
tuni
sti
cinf
ect
ions
andsi
deef
fect
soft
hedr
ugsusedf
ort
het
reat
mentordr
ugsusedf
ort
hecompl
i
cat
ing
i
nfect
ion(
9,10)

Anemi
a,t
hrombocy
topeni
a,andneut
ropeni
aar
ecommonmani
fest
ati
onsi
npat
ient
swi
th

2
HI
V i
nfect
ion t
hatbecome mor
efr
equentand sev
ere wi
th pr
ogr
essi
on f
rom t
he
asy
mpt
omat
icst
atet
oAI
DS.Toensur
ebet
termanagementpr
otocolf
orpat
ient
sinf
ect
ed
wi
thHI
Vandi
mpr
ovi
ngt
hei
rqual
i
tyofl
i
fe,i
tisnecessar
ytol
ooki
ntot
hei
rhemat
ologi
cal
pr
ofi
l
e,whi
chf
ormst
hepr
eli
minar
yinv
est
igat
ioni
nmostai
l
ingpeopl
epr
esent
ingt
oheal
th
car
e pr
ofessi
onal
s.An assessmentofhemat
ologi
calpr
ofi
l
e hel
ps t
he phy
sici
an i
n
i
nst
it
uti
ngpr
opert
reat
ment(
9,10,
and11)
.

Genderbased di
ff
erencesofHI
V/AI
DS pr
eval
ence mayoccurdepend on pat
ter
nsof
di
seaset
ransmi
ssi
onandst
ageoft
hedi
sease.Hi
ghHI
Vpr
eval
encef
oundamongwomen
si
ncet
hemai
ntr
ansmi
ssi
onpat
ter
nishet
erosexual
;hencewomenar
emor
eexposedt
o
HI
Vinf
ect
ion.Manywomenar
einf
ect
edwi
thHI
V,becausewomenhav
eagr
eat
ermucosal
sur
facear
eaexposedt
opat
hogensandi
nfect
iousf
lui
dforl
ongerper
iodsdur
ingsexual
i
nter
cour
seandar
eli
kel
ytof
acei
ncr
easedt
issuei
njur
y(12)
.

HI
V/AI
DScanbedi
agnosedt
hroughr
api
ddi
agnost
ict
est
sthatdet
ectant
ibodi
espr
oduced
byt
heper
sonaspar
toft
hei
rimmuner
esponset
ofi
ghtHI
V.I
nmostcases,
peopl
edev
elop
ant
ibodi
est
oHI
Vwi
thi
n28day
sofi
nfect
ion.Dur
ingt
hist
ime,peopl
eexper
iencet
heso-
cal
l
ed“
window”per
iodwhenHI
Vant
ibodi
eshav
en’
tbeenpr
oducedi
nhi
ghenoughl
evel
sto
bedet
ect
edbyst
andar
dtest
sandwhent
heymayhav
ehadnosi
gnsofHI
Vinf
ect
ion,but
al
sowhent
heymayt
ransmi
tHI
Vtoot
her
s(13)
.

HI
Vvi
rusi
nfect
ion cannotbecur
ed buti
tcan bet
reat
ed byant
ir
etr
ovi
ralt
her
apy
,a
combi
nat
ionofdai
l
ymedi
cat
ionst
hatst
opt
hev
irusf
rom r
epr
oduci
ng.I
thel
pst
opr
otect
CD4cel
l
s,keepi
ngt
hei
mmunesy
stem st
rongenought
otakemeasur
esagai
nstdi
sease.
Ant
ir
etr
ovi
ralt
her
apyhel
pskeepHI
Vfr
om pr
ogr
essi
ngt
oAI
DS.I
tal
sohel
psr
educet
her
isk
oft
ransmi
tt
ing HI
Vto ot
her
s.When t
reat
menti
s ef
fect
ive,t
he v
irall
oad wi
l
lbe
“
undet
ect
abl
e.”Theper
sonst
il
lhasHI
V,butt
hev
irusi
snotv
isi
blei
ntest(
14)
.

3
 1.
2St
atementofpr
obl
em
HI
Vinf
ect
sat
ypeofwhi
tebl
oodcel
lint
hebody
’si
mmunesy
stem cal
l
edaT-
hel
percel
l
(
alsocal
l
edaCD4cel
l
)whi
chi
sthev
italcel
l
skeepusheal
thybyf
ight
ingof
finf
ect
ionsand
di
seases.t
hev
irusat
tachesi
tsel
ftoaT-
hel
percel
landf
useswi
thi
t(j
oinst
oget
her
).I
tthen
t
akescont
roloft
hecel
l
’sDNA,makescopi
esofi
tsel
finsi
det
hecel
l
,andf
inal
l
yrel
eases
mor
eHI
Vint
othebl
ood.I
twi
l
lcont
inuet
omul
ti
plyandspr
eadt
hroughoutt
hebodybyt
he
pr
ocesscal
l
edt
heHI
Vli
fecy
cle(
7).

HI
Vweakenst
hebody
’snat
uraldef
ensesandov
ert
imesev
erel
ydamagest
hei
mmune
sy
stem and causeshemat
ologi
calabnor
mal
i
tieswhi
char
ecommoncompl
i
cat
ionsof
humani
mmunodef
ici
encyv
irusi
nfect
ion.Theseabnor
mal
i
tiesi
ncr
easeast
hedi
sease
adv
ancesi
nbot
hant
ir
etr
ovi
ral
treat
edandunt
reat
edi
ndi
vi
dual
s(7,
9).

HI
V br
ingsa wi
de r
ange ofi
mmunol
ogi
caland hemat
ologi
calchangest
hati
ncl
udes
depl
eti
on i
n CD4+ T cel
l
,cy
toki
ne dy
sregul
ati
on and i
mmune dy
sfunct
ion wher
ethe
domi
nanti
mmunol
ogi
cfeat
ureofHI
Vinf
ect
ioni
spr
ogr
essi
vedepl
eti
onoft
hehel
perTcel
l
(
CD4+ T cel
l
),whi
ch r
ever
ses t
he nor
malCD4:
CD8 r
ati
o and subsequent
lyl
ead t
o
i
mmunodef
ici
ency(
10)
.

HI
V/AI
DScanbr
ingsSt
igmat
opeopl
eli
vi
ngwi
thHI
V/AI
DS “
ani
nfl
uent
ial
,yetdi
sgr
acef
ul
soci
all
abelt
hatcompl
etel
ychangest
hewaypeopl
eper
cei
vet
hemsel
vesandhowt
heyar
e
seenasi
ndi
vi
dual
sbyt
hesoci
ety
.St
igmat
izat
ionanddi
scr
imi
nat
ionagai
nstPLWHAhav
e
si
gni
fi
cant
lyl
i
mit
sthe success and negat
ivel
yimpactpr
ogr
ess and ef
for
ts as i
t
pr
edi
sposest
opooradher
encet
omedi
cat
ions,
unwi
l
li
ngnesst
oaccesscar
eandul
ti
mat
ely
r
educedt
hequal
i
tyofl
i
fe(
15)
.

Anemi
aist
hemostcommonhemat
ologi
calabnor
mal
i
tyi
nHI
Vposi
ti
vepat
ient
sandt
he
r
iskf
act
orf
orear
lydeat
hinpat
ient
swi
thAI
DS.Thei
nci
denceofanemi
aincr
easeswi
th
pr
ogr
essi
onofHI
Vinf
ect
ionandsev
eralot
heret
iol
ogi
cfact
orsmayal
sobei
nvol
vedi
nthe

4
dev
elopment of HI
V-associ
ated anemi
a, i
ncl
udi
ng mi
cronut
ri
ent def
ici
enci
es,
i
mmunol
ogi
calmy
elosuppr
essi
on,i
mpai
reder
ythr
opoi
eti
npr
oduct
ionandbl
oodl
ossf
rom
i
ntest
inal
oppor
tuni
sti
cdi
sease(
9,16)
.

Womenar
eatagr
eat
erphy
siol
ogi
calr
iskofcont
ract
ingHI
Vthanmen,
becauseofwomen
hav
eagr
eat
ermucosalsur
facear
eaexposedt
opat
hogensandi
nfect
iousf
lui
dforl
onger
per
iodsdur
ingsexuali
nter
cour
seandar
eli
kel
ytof
acei
ncr
easedt
issuei
njur
y.Par
ti
cul
arl
y,
Youngwomenar
eathi
ghr
iskduet
oimmat
uri
tyoft
heopeni
ngoft
hewomb(
cer
vix)
,whi
ch
hasnotacqui
redsuf
fi
cientt
hicknesst
oactasanef
fect
ivebar
ri
er,t
her
ebyf
aci
l
itat
ing
gr
eat
erexposur
eoft
argetcel
l
stot
raumaandpat
hogensi
nthev
agi
na(
12)
.

HI
Vinf
ect
ioncausesmar
kedhemat
ologi
calchangest
hatcompl
i
cat
eheal
thandt
reat
ment
ofpat
ient
sandi
thi
nder
sther
apyt
owar
dspr
imar
yinf
ect
ion,oppor
tuni
sti
cinf
ect
ionsor
associ
atedneopl
asm (
7).

HI
Vcausesmar
rowdef
ect
sandi
mmunecy
topeni
ast
hati
scausedbyHI
Vinf
ect
ion,
eit
her
di
rect
lyt
othebonemar
row,oppor
tuni
sti
cinf
ect
ions,dev
elopmentofl
ymphomaasa
secondar
yneopl
asm andsi
deef
fect
soft
hedr
ugsusedf
ort
het
reat
mentordr
ugsusedf
or
t
hecompl
i
cat
ingi
nfect
ionorl
ymphoma(
10)
.

1.
3Resear
chQuest
ions
1.Whi
cht
ypesofourbl
oodcel
l
sdoesHI
V/AI
DSaf
fect
s?

2.HowHI
V/AI
DScanweakenouri
mmunesy
stem?

3.Whatt
ypesofi
mmunol
ogi
calandhemat
ologi
calchanges,doesHI
V/AI
DSbr
ingst
o
ourbl
oodcel
l
s?

5
 4.Whatar
ethechal
l
engesofHI
V/AI
DSt
oourper
cei
ve,
soci
all
i
fe,
successandqual
i
ty
ofl
i
fe?

5.WhydoWomenar
eatagr
eat
erphy
siol
ogi
cal
riskofcont
ract
ingHI
Vthanmen?

1.
4Si
gni
fi
canceoft
hest
udy

St
udy
ingt
hei
mpactofHI
Vont
hehemat
opoi
esi
sofHI
Vpat
ient
sisv
eryessent
ialf
ort
he
managementandcar
eofpeopl
eli
vi
ngwi
thHI
V/AI
DS.I
nvest
igat
ingt
hehemat
ologi
cal
pr
ofi
l
esbef
oreandaf
terr
ecei
vi
ngARTi
simpor
tant
,becausespeci
fi
cint
erv
ent
ionot
her
t
hanant
ir
etr
ovi
ral
treat
mentmaybei
ndi
cat
edf
ori
tscor
rect
ion.

Despi
tet
hepr
esenceoff
ew r
epor
tsont
hehemat
ologi
calpar
amet
ersofHI
V posi
ti
ve
i
ndi
vi
dual
sinEt
hiopi
a,st
udyconduct
edt
oaccesst
hehemat
ologi
calpr
ofi
l
esbot
hbef
ore
and af
terr
ecei
vi
ng Ant
ir
etr
ovi
ral(
ART)ar
eli
mit
ed.Thi
s st
udy wi
l
lpr
ovi
de f
urt
her
i
nfor
mat
ionaboutt
hechangei
nthehemat
ologi
calpr
ofi
l
e.Mor
eov
ert
hisst
udycanser
ve
asar
efer
encemat
eri
alf
orf
urt
herr
esear
cheswi
thr
egar
dtohemat
ologi
calpr
ofi
l
esi
nHI
V
pat
ient
s.

Si
ncet
hehemat
ologi
calpr
ofi
l
esabnor
mal
i
tiesi
nHI
Vpat
ient
sleadt
oanemi
a,neut
ropeni
a
andt
hrombocy
topeni
awhi
chcausemor
bidi
ti
esandmor
tal
i
ties,knowi
ngt
hest
udyoft
he
pr
eval
enceofhemat
ologi
cal
prof
il
esabnor
mal
i
tiesi
nHI
Vpat
ient
swasv
eryi
mpor
tant
.

Theai
m oft
hisst
udyi
sther
efor
etoasseshemat
ologi
calpr
ofi
l
esamongHI
V posi
ti
ve
pat
ienti
ndi
vi
dual
sbef
oreandaf
terst
art
ingant
ir
etr
ovi
ralt
her
apy(
ART)atARTcl
i
nicof
Bi
shof
tuHospi
tal
.

6
 2.Li
ter
atur
erev
iew
I
nthepr
esentst
udy
,themostcommonhemat
ologi
calmani
fest
ati
onsf
oundwer
eanemi
a,
l
eucopeni
a,and t
hrombocy
topeni
a.The f
requency and sev
eri
tyt
hese hemat
ologi
cal
mani
fest
ati
oni
ncr
easewi
tht
hedecl
i
nei
nCD4countandhav
egotasi
gni
fi
canti
mpacton
cl
i
nicalout
comesandpat
ient
’squal
i
tyofl
i
fe.Henceal
lpat
ient
sshoul
dbei
nvest
igat
edf
or
hemat
ologi
calabnor
mal
i
tiesandt
reat
edaccor
dingl
ytor
educet
hemor
bidi
tyandmor
tal
i
ty
(
17)

Thepr
eval
enceofbasel
i
necy
topeni
awashi
ghat65%andi
npar
ti
cul
ar48%ofourst
udy
popul
ati
onwasanemi
c.Ourf
indi
nghav
eshownt
hati
nit
iat
ionofHAARTi
mpr
oves l
evel
s
andcor
rect
sanemi
aev
enwhenAZT-basedHAARTi
sasaf
ir
stl
i
ner
egi
meni
nsour
ce
l
i
mit
edset
ti
ngs.Ot
hersel
ect
edhemat
ologi
calpar
amet
ersmayhav
evar
iousr
esponset
o
HAARTwi
thsomei
mpr
ovi
ngsuchast
heWBCcountandot
herpot
ent
ial
l
ywor
seni
ngsuch
ast
hepl
atel
etcount(
18)

Ther
ewassi
gni
fi
canti
ncr
easei
nCD4+Tcel
lcount
,WBCcount
,Neut
rophi
l
,Ly
mphocy
te,
hemogl
obi
n,MCV,MCHC,andpl
atel
etsaf
tersi
xmont
hsofHAART,whi
l
ether
ewasa
decr
easei
nthest
atusofr
edcel
ldi
str
ibut
ionwi
dth(
RDW)andcountr
edcel
l(RBCs)
compar
ed t
o basel
i
ne.Anemi
a,l
eucopeni
a,neut
ropeni
a,l
ymphopeni
a,wer
ecommonl
y
pr
eval
enthemat
ologi
calabnor
mal
i
tyencount
eredi
nadul
twi
thHI
V/AI
DSandal
soonhi
ghl
y
act
iveant
ir
etr
ovi
ralt
her
apybutt
hepr
eval
enceoft
heabnor
mal
i
tieswer
esi
gni
fi
cant
ly
r
educedaf
teri
nit
iat
ionofART(
11)

The commonesthemat
ologi
calabnor
mal
i
ties i
n st
udy par
ti
cipantwer
e anemi
a and
l
eucopeni
a,especi
all
yneut
ropeni
a.Pr
eval
enceanemi
awashi
ghi
nART naï
vePat
ient
s
whi
l
eleucopeni
aandneut
ropeni
apr
eval
encewashi
gheri
npat
ient
sonHAART.Anemi
a,

7
l
eucopeni
a,t
hrombocy
topeni
awer
eincr
easedasCD4countdecr
eases.Basedont
he
pr
esentf
indi
ngs,
HIVpat
ient
sar
erecommendedt
ocheckupt
hei
rCD4count
sregul
arl
yand
t
ost
artARTi
nor
dert
odecr
easet
hepr
eval
enceofanemi
a(19)
.

Thehemat
ologi
calabnor
mal
i
tiesobser
vedi
nthi
sst
udyar
ever
yhi
ghi
mmunosuppr
essi
on
andanemi
a.Thi
shi
ghpr
eval
encemaybeassoci
atedwi
thdel
ayv
isi
ttoARTpr
ovi
ding
i
nst
it
uti
on.Hencet
heassoci
ati
onofheal
thseeki
ngbehav
iororHI
Vposi
ti
vepat
ient
sand
t
hest
ateofhemat
ologi
cal
mani
fest
ati
onneedt
obeunder
stood(
20)

Thebasi
chemat
ologi
calpar
amet
ersl
i
kehemogl
obi
n,t
otall
eucocy
tecountal
ongwi
th
pl
atel
etcountcanbeusedasaper
spect
ivescr
eeni
ngt
estt
oassesst
hesev
eri
tyand
pr
ogr
essofHI
Vinf
ect
ionwhenCD4counti
snotav
ail
abl
e,especi
all
yindev
elopi
ngcount
ry
l
i
keI
ndi
awhenf
inanci
alr
esour
cear
esl
i
ght
lyl
i
mit
ed.Thesepar
amet
erscanbeusedt
o
assess t
he r
esponse t
o ant
ivi
ralt
reat
ment
.Hence cl
i
nici
ans can ut
il
ize t
hese basi
c
i
nvest
igat
ionr
eadi
l
yav
ail
abl
eatal
lmedi
cal
cent
erswhi
l
etr
eat
ingHI
Vinf
ect
edpat
ient
s(21)

Ther
ewasdecl
i
nei
nthepr
eval
enceanemi
aandi
ncr
ementofmeanCD4+Tcel
lcount
amongHI
Vinf
ect
edpat
ient
saf
terHAARTi
nit
iat
ion.Bef
oreHAARTi
nit
iat
ionHI
Vpat
ient
s
hav
esi
gni
fi
cant
lyhi
gherpr
eval
enceofanemi
athant
hoseaf
terHAART i
nit
iat
ion.The
pr
eval
enceofanemi
awassi
gni
fi
cant
lyhi
gheri
ninpat
ient
swi
thCD4count<200cel
l
/µl
(15)

8
 3.Hy
pot
hesi
s
3.
1TheNul
lhy
pot
hesi
s(HO)
 Ther
eisnosi
gni
fi
cantdi
ff
erencei
nhemat
ologi
calpr
ofi
l
ebef
orei
nit
iat
ionofART
andaf
teratl
east6mont
hsofARTi
nit
iat
ion

TheAl
ter
nat
ivehy
pot
hesi
s(HA)

 Ther
eisasi
gni
fi
cantdi
ff
erencei
nhemat
ologi
calpr
ofi
l
esbef
orei
nit
iat
ionofART
andaf
teratl
eastsi
xmont
hofARTi
nit
iat
ion.

9
10
 4.Obj
ect
ives
4.
1Gener
alobj
ect
ive
 Toasseshemat
ologi
calpr
ofi
l
esamongHI
Vposi
ti
vei
ndi
vi
dual
staki
ngAnt
ir
etr
ovi
ral
Ther
apy(
ART)atBi
shof
tuHospi
tal
.

4.
2Speci
fi
cobj
ect
ives
 Todescr
ibesel
ect
edhemat
ologi
calpar
amet
ers(
WBCwi
thDi
ff
.count
s,RBC,Hgb,
RBCi
ndi
ces,pl
atel
ets,andCD4+Tcel
lcount
s)ofpeopl
eon Ant
ir
etr
ovi
ralTher
apy
bef
oreandaf
terARTt
reat
menti
nit
iat
ion.

 Todet
ermi
net
hemagni
tudeofhemat
ologi
calabnor
mal
i
tiesbef
oreandaf
terART
i
nit
iat
ion.

11
 5.Mat
eri
alsandMet
hods
5.
1St
udyar
ea
Thest
udywasconduct
edi
nBi
shof
tuGener
alHospi
talARTcl
i
nicWhi
chi
sfoundat47km
f
rom Addi
sAbabat
owar
dEast
,inEastShewa,Or
omi
aregi
on.Thehospi
tali
slocat
edi
n
kebel
e04 i
n Bi
shof
tut
own.Andt
hehas1,
250,
000t
otalpopul
ati
onsi
nit
scat
chmentar
ea.
TheHospi
tal
alsocont
ains05Heal
thcent
erst
hatar
efoundi
nit
sment
orshi
p.

TheARTf
oll
ow upcl
i
nici
sschedul
eddai
l
ybot
hint
hemor
ningandaf
ter
noon.Thecl
i
nic
st
aff
sar
e03Heal
thOf
fi
cer
s,01Doct
or,06casemanager
s,03dat
acl
erksand06ot
her
CDCst
aff
s.Theav
eragenumberofpat
ient
sret
urni
ngf
orf
oll
owupwas30t
o50pat
ient
s
perday
.TheHospi
talst
art
eddel
i
ver
ingARTser
vicesbef
ore18y
ear
sandcur
rent
ly,t
her
e
ar
e3834HI
Vposi
ti
vei
ndi
vi
dual
senr
oll
edi
nregi
str
ati
on.

5.
2St
udyper
iod
Thest
udywasconduct
edf
rom Mayt
oJul
y,2021

5.
3St
udydesi
gn
Thi
swasacr
oss-
sect
ionalst
udyofHI
V-i
nfect
edcl
i
ent
swhoenr
oll
edatt
heHI
Vcl
i
nicof
Bi
shof
tuGener
alHospi
talbet
weenJune2020andMay2021.Par
ti
cipant
shaddat
ataken
f
orcompl
etebl
oodcountandCD4count
s,whi
char
efr
eer
out
inepr
e-r
equi
sit
eandpr
e-
t
reat
mentev
aluat
ionsdonef
oral
lregi
ster
edHI
Vpat
ient
satBi
shof
tuGener
alHospi
tal
.

5.
4Sour
cepopul
ati
on

12
Al
lHI
V pat
ient
sat
tendi
ngatBi
shof
tuGener
alHospi
talART cl
i
nicwer
ethesour
ceof
popul
ati
on.

5.
5St
udypopul
ati
on
Thest
udypopul
ati
onwer
eHI
Vinf
ect
edPat
ient
swhomeett
hei
ncl
usi
oncr
it
eri
aandhad
st
art
edt
aki
ngART(
def
inedast
aki
ngt
woormor
eant
ir
etr
ovi
raldr
ugf
oratl
east6mont
hs)
,
byWor
ldHeal
thOr
gani
zat
ion(
WHO)cl
i
nicalandi
mmunol
ogi
calcr
it
eri
aandwho had
compl
etebl
oodcount(
CBC)andCD4count
stakenatt
het
imeofHAARTi
nit
iat
ion,and
af
ter6mont
hsoft
reat
menti
nit
iat
ion.

5.
5Sampl
esi
zedet
ermi
nat
ion
Wewi
l
luseasi
ngl
epopul
ati
onusi
ngpr
opor
ti
onof66%(
i.
e.p=0.
66)f
ormaxi
mum sampl
e
si
ze

Wher
e,ni
= i
nit
ial
sampl
esi
ze

z=conf
idencei
nter
val
95%,
=1.
96

p=popul
ati
onpr
opor
ti
ont
hreshol
dsst
udysubj
ect
sw/
cis50%

d=mar
ginofer
ror5%

Thepopul
ati
onsi
zewascal
cul
atedusi
ngt
hef
ormul
aforsi
ngl
epopul
ati
onasexpr
essed
bel
ow

2
Sampl
esi
ze(
n)=(
zᾳ)2p(
1-p)
/d

2
(
1.96)2x0.
66(
1-0.
66)
/(0.
05)=345

nf=(
ni/
(1+ni
/N)
)nf
,= 383/
(1+(
384/
136)
)=100

Wi
th10%ofnon-
responser
atear
e10.Thent
hef
inal
sampl
esi
zei
sN=136

5.
6Sampl
i
ngt
echni
que
Conv
eni
entsampl
i
ngmet
hodwasappl
i
edf
ordat
acol
l
ect
ion.HI
Vinf
ect
edi
ndi
vi
dual
swho
camet
oARTcl
i
nicdur
ingt
hest
udyper
iodandt
hosewhomett
hei
ncl
usi
oncr
it
eri
awer
e

13
i
ncl
udedi
nthi
sst
udy
.

5.
7Sel
ect
ioncr
it
eri
a

AI
ncl
usi
oncr
it
eri
a
 HI
Vposi
ti
vepat
ient
sofal
lagesi
ncl
uded

 Thosewhower
eonARTf
oratl
eastf
or6mont
hsandhadf
oll
owup

 Pat
ient
shav
ingcompl
eteCBCandCD4countatt
hebasel
i
ne(
pre-
ART)
.

B.Excl
usi
oncr
it
eri
a
 Pat
ient
swhower
esev
erel
ysi
ckduet
oot
hermedi
cal
condi
ti
on

 Thoseusi
ngmedi
cat
ionf
oranemi
a,neut
ropeni
aort
hrombocy
topeni
a.

 Thosewhower
edi
agnosedashav
inghemat
ologi
caldi
seaseofanyi
dent
if
iedcause
(
incl
udi
nghemol
yti
canemi
a,t
hrombocy
topeni
a,l
eukemi
a,andhemogl
obi
nopat
hy)
bef
oreARTi
nit
iat
ion.

 Thosewhower
eonmedi
cat
ion(
ant
ibi
oti
cs,v
itami
nsuppl
ement
s,TBt
reat
mentand
i
mmunosuppr
essi
vedr
ugs)atst
udy
ingt
ime.

 Pr
egnantwomen

5.
8St
udyv
ari
abl
es

5.
8.1Dependentv
ari
abl
es
 Hemat
ologi
calpar
amet
ers(
CD4+ T cel
l
,RBC,Hgb,RBC i
ndi
ces,WBC wi
th
Di
ff
erent
ial
andpl
atel
ets.
)

5.
8.2I
ndependentv
ari
abl
es
 Sex,
WHOcl
i
nical
stages,
typesofARTr
egi
menanddur
ati
onofART

5.
9Oper
ati
onal
def
ini
ti
on

14
Anemi
a:Hemogl
obi
nconcent
rat
ionof<13g/
dlf
ormal
eand<12g/
dlf
orf
emal
e

Mi
l
dAnemi
a:Hemogl
obi
nval
ueof11g/
dlt
o12.
9g/
dlf
ormal
eand11g/
dlt
o11.
9g/
dlf
or
f
emal
e.

Moder
ateAnemi
a:hemogl
obi
nval
ueof8g/
dlt
o10.
9g/
dlf
ormal
eandf
emal
e.

Sev
ereAnemi
a:Hemogl
obi
nval
ueof<8g/
dlf
ormal
eandf
emal
e.

Thr
ombocy
topeni
a:Apl
atel
etcountof<150,
000cel
l
s/µl

Leucopeni
a:Tot
alWBCcountof<4000cel
l
s/µl

Neut
ropeni
a:Absol
uteneut
rophi
lcount<1500cel
l
s/µl

Ly
mphopeni
a:Tot
all
ymphocy
tecountof<1000cel
l
s/µl

I
mmunosuppr
essi
on:wasdef
inebased ont
heCD4 countaspert
heWHO gui
del
i
ne.
Accor
dingl
yaCD4count<200cel
l
s/µlassev
erei
mmunosuppr
essi
on,200-
349cel
l
s/µl
adv
ancedi
mmunosuppr
essi
on,
and350-
499cel
l
s/µlmi
l
dimmunosuppr
essi
on.

5.
10.Dat
acol
l
ect
iont
ool
andt
estpr
ocedur
es

5.
10.
1Dat
acol
l
ect
ioni
nst
rument
s
Thef
oll
owi
ngdat
acol
l
ect
ioni
nst
rument
swer
eused.

 St
ruct
uredquest
ionnai
reused

 EDTAcoat
edv
acuum f
orcol
l
ect
ionofbl
oodsampl
e

 Sy
smex-
550hemat
ologyanal
yzerf
orCBCanal
ysi
s

 FACSPr
est
oCD4anal
yzerf
ordet
ermi
nat
ionofCD4count
.

 Di
ff
erentt
ypesofr
eagent
susedf
ordet
ermi
nat
ionofCD4countCBCanal
ysi
s.

5.
10.
2Dat
acol
l
ect
ionpr
ocedur
e
St
ruct
uredquest
ionnai
rewasusedf
ordat
acol
l
ect
ion.Thequest
ionnai
rewasdev
elopedi
n
Engl
i
shandt
ransl
atedi
ntoAf
anOr
omol
anguage.Thequest
ionnai
reshadt
hreepar
ts.The

15
f
ir
stpar
tforcol
l
ect
ingdat
aaboutsoci
o-demogr
aphi
cchar
act
eri
sti
csoft
hest
udysubj
ect
s,
t
hesecondpar
tforcol
l
ect
ingdat
aconcer
ningbasel
i
nechar
act
eri
sti
csoft
hei
ndi
vi
dual
bef
orei
nit
iat
ionofARTmai
nlycl
i
nical
,labor
ator
yandi
mmunol
ogi
calchar
act
eri
sti
cs.The
t
hir
dpar
twasf
orcol
l
ect
ingdat
arel
atedt
oARTt
reat
mentandchangesassoci
atedwi
th
basel
i
nepar
amet
ers(
adv
erseef
fect
s)af
tert
aki
ngART.

Bef
oret
he i
nter
view,br
iefexpl
anat
ion was gi
ven t
othe st
udy par
ti
cipant
s by t
he
i
nvest
igat
oraboutt
hepur
poseoft
hest
udy
.

Dat
aonSoci
o-demogr
aphi
c,cl
i
nicalchar
act
eri
sti
csandbasel
i
ne(
preART)i
nfor
mat
ionof
t
hest
udypar
ti
ci
pant
swascol
l
ect
edbyi
nter
viewandr
evi
ewofmedi
cal
recor
ds.

5.
11 Bl
oodspeci
mencol
l
ect
ion
Af
teri
nter
view anddet
ail
edr
evi
ew oft
hemedi
calr
ecor
dthest
udysubj
ect
swer
esentt
o
l
abor
ator
y.Av
olumeof3mlv
enousbl
oodwast
akenf
rom f
orear
m ant
ecubi
talv
einwi
th
appr
opr
iat
easept
ict
echni
quebyexper
iencedl
abor
ator
yper
sonnel
.Thebl
oodsampl
ewas
col
l
ect
edbyv
acuum t
ubewi
thEDTA coat
edant
icoagul
ant
.Wi
thi
n1-
2hour
sofbl
ood
col
l
ect
ionsampl
ewer
etr
anspor
tedt
olabor
ator
yoft
heHospi
talf
oranal
ysi
s.Compl
ete
bl
oodcountanal
ysi
swasper
for
medbyusi
ngSy
smex-
550hemat
ologyanal
yzerandCD4
countwasdonebyusi
ngBDFACSPr
est
oCD4anal
yzer
.Ther
esul
twascol
l
ect
edwi
thi
n6
hour
sandf
il
ledondat
acol
l
ect
ionf
ormat
.

5.
12 Reagent
susedf
orHemat
ologyanal
ysi
sandCD4count
Sy
smex550CBC hemat
ologyanal
yzerusesCel
l
-pack,WDFl
yser
,WDFsul
fol
yser
,and
f
lor
ouscel
l
s.Andal
soBDFACSPr
est
oCD4countusescar
tri
dger
eagentandCD4pr
est
o
paper
.

5.
13 Dat
aqual
i
tycont
rol
To ensur
e good qual
i
tydat
athe per
for
mance oft
he hemat
ologyanal
yzerand CD4
count
er’
ssy
stem wer
econt
rol
l
edbyr
unni
ngqual
i
tycont
rolmeasur
ement
sbef
oreanal
ysi
s

16
oft
hesampl
e.Thequal
i
tyoft
hedat
athatgi
vesr
eli
abi
l
ityandr
epr
esent
ati
venesst
othe
st
udywasmai
ntai
nedbyi
ncor
por
ati
ngonl
ythecompl
etedat
aoft
hewi
thi
nthest
udy
per
iod.Thecol
l
ect
eddat
awascheckedatdi
ff
erentl
evelofcompl
etenessandconsi
stency
byt
hepr
inci
pal
inv
est
igat
oratt
heendofeachday
.

Whenev
eraner
rorwasf
oundatanyl
evel
,thei
nvest
igat
ort
racedbackandcor
rect
edasi
t
needed

5.
14 Dat
apr
ocessi
ngandanal
ysi
s
Thedat
awascoded,cl
eaned,ent
eredandanal
yzedusi
ngSPSSv
ersi
on20st
ati
sti
cal
sof
twar
e.Descr
ipt
ive anal
ysi
s was done and r
esul
ts wer
e pr
esent
ed as numberand
per
cent
ageormean±SD.Descr
ipt
ivest
ati
sti
cs(
mini
mum,maxi
mum,meanandst
andar
d
dev
iat
ion)wer
eappr
opr
iat
elyappl
i
edi
nthecour
seofanal
ysi
s.Pai
redT-
testwasusedf
or
compar
isonofmeanv
alueofhemat
ologi
calpar
amet
ersbef
oreandaf
terARTi
nit
iat
ion.
Onewayanal
ysi
sofv
ari
ancewasusedt
ocheck t
hepr
esenceofsi
gni
fi
cantdi
ff
erencei
n
hemat
ologi
calv
aluesoft
hesubj
ect
sacr
ossdi
ff
erentWHO st
ageoft
hedi
sease.The
r
esul
tsoft
heanal
ysi
swer
epr
esent
edwi
tht
abl
esandf
igur
eswher
eappr
opr
iat
e.I
nal
l
casesp.v
alueofl
esst
han0.
05wasconsi
der
edasst
ati
sti
cal
l
ysi
gni
fi
cant
.

5.
15 Et
hical
consi
der
ati
on
Bef
ore st
art
ing dat
a col
l
ect
ion l
ett
erofr
ecommendat
ion f
rom Ri
ftv
all
eyuni
ver
sit
y
Medi
calCol
l
ege f
acul
tyofheal
th sci
ence was t
aken and per
missi
on obt
ained f
rom
concer
nedadmi
nist
rat
ivebodi
esaf
terv
eri
fyi
ngaboutt
hest
udyt
hent
hei
nfor
mat
ionf
rom
t
her
espondent
sbykeepi
ngconf
ident
ial
i
tyandexcl
udi
ngt
henameofr
espondent
sfr
om t
he
quest
ionnai
res.

5.
16 Pl
anf
ordi
ssemi
nat
ionoff
indi
ngs
Af
tercompl
eti
ont
hest
udy
,ther
esul
twi
l
lbepr
esent
ed andsubmi
tt
edt
oRi
ftVal
l
ey
Uni
ver
sit
ydepar
tmentofMedi
calLabor
ator
yandt
hecopywi
l
lbegi
vent
othesel
ect
ed
st
udyFaci
l
iti
es.

17
 6.Resul
t
6.
1Soci
o-demogr
aphi
cchar
act
eri
sti
cs
At
otalof136HI
Vinf
ect
edi
ndi
vi
dual
swer
eincl
udedi
nthepr
esentst
udy
.Thei
rages
r
angedf
rom 20t
o69y
ear
swi
thameanageof39.
6±9.
8year
sandamedi
anageof41
y
ear
s.Maj
ori
ty(
34.
6%)oft
heagegr
oupswer
ebet
ween40y
ear
sto49y
ear
s,wher
easonl
y
2.
2%oft
hem f
elli
ntheagegr
oupbet
ween60y
ear
sto69y
ear
s.Outoft
he136pat
ient
s,
55.
2%wer
efemal
esand44.
8%wer
emal
es,
giv
ingaf
emal
etomal
erat
ioof1.
3to1.

For
tyei
ght(
48.
9%)oft
hepar
ti
cipant
swer
emar
ri
ed.Maj
ori
tyoft
hest
udypar
ti
cipant
sby
Et
hni
cit
ywer
eOr
omoandAmhar
a,35.
3% and31.
6respect
ivel
y.andal
so43.
4% wer
e
or
thodoxChr
ist
ianf
oll
owedbypr
otest
antandMusl
i
m,30.
9% and25.
0respect
ivel
y.The
maj
ori
tyofeducat
ionalst
atusoft
hepar
ti
cipant
satt
het
imeoft
hest
udywaspr
imar
y
school
,47.
0%f
oll
owedbyhi
ghschool
30.
1%.

Regar
dingt
otheempl
oymentst
atusoft
hepar
ti
cipant
s,34.
5%wer
eunempl
oyedand29.
4%,
19.
2% and 16.
9% wer
e sel
f-
empl
oyed,empl
oyed i
n publ
i
c or
gani
zat
ion and pr
ivat
e
or
gani
zat
ionr
espect
ivel
y(Tabl
e3)
.

18
Table 3፡Soci
odemographi
c char
acter
isti
cs ofHI V posi
ti
vei
ndivi
dual
st aki
ng ART at
Bishoft
uHospit
alARTuniti
n2021
Var i
ables Frequency(
n=136) Relat
ivef
requency(
%)
Age( years)
<20 0 0
20-29 17 12.5
30-39 41 30.1
40-49 47 34.6
50-59 28 20.6
60-69 3 2.2
>70 0 0.0
Sex
Mal e 61 44.8
Femal e 75 55.2
Mar it
alstat
us
Single 30 20.0
Divorced 24 16.9
Mar ri
ed 68 48.9
Wi dowed 16 11.7
Ethnicit
y
Oromo 48 35.3

19
 Amhar a 43 31.
6
Ti
gr e 3 2.
2
Gurage 10 7.
4
Others 32 23.
5
Religi
on
Orthodox 59 43.
4
Catholic 1 0.
7
Protestant 42 30.
9
Musl i
m 34 25.
0
Others 0 0
Educat i
onalstat
us
I
ll
iterate 8 6.
0
Pri
mar y 64 47.
0
Highschool 41 30.
1
Certif
icateandabov e 23 16.
9
Empl oymentandst atus
Empl oyedinpublicorganizati
on 26 19.
2
Empl oyedinpriv
ateor ganizat
ion 23 16.
9
Selfempl oyed 40 29.
4
Unempl oyed 47 34.
5
6.
2.I
mmunol
ogi
cal
par
amet
ers
Thest
udysubj
ect
shadabasel
i
neCD4countr
angi
ngf
rom 14-
576cel
l
s/μlandmedi
anof
142cel
l
s/μl
.ThemeanCD4countatt
hebasel
i
newas162.
5±108.
6cel
l
s/μl
.Af
ter6
mont
hs ofART,t
he CD4 countshowed an i
ncr
ement
,whi
ch account
s a mean of
347±183.
17cel
l
s/μlandamedi
anof316cel
l
s/μl
.Thei
ncr
ement
sofCD4count
swer
e
si
gni
fi
cantf
orbot
hsexeswi
thp-
val 001(
ue<0. Tabl
e3,
Figur
e1.
).

20
 Fi
gur
e1:Mean
val
ues ofCD4
count among
HI
V posi
ti
ve
adul
t
i
ndi
vi
dual
s
t
aki
ng ART at
t
he basel
i
ne
and af
ter 6
mont
hsofART
atBi
shof
tuGener
alHospi
talARTuni
t,Bi
shof
tu,
Oromi
a,2021,

6.
3Hemat
ologi
calVal
uesbef
oreandaf
teri
nit
iat
ionofART
As shown i
ntabl
e 4,t
he mean WBC countand ANC i
ncr
eased and f
ound t
o be
5.
52±2. 103/
14x μl,and2. 57x103/
99±1. μlatt
hebasel
i
neand6. 18x103 /
19±2. μland
3. 59x103μlaf
25±1. teratl
east6mont
hsofr
ecei
vi
ngART.

MeanRBCcountwer
e4. 71×106/
41±0. μlatt
hebasel
i
neand4. 59×106/
28±0. μlaf
terat
l
east6mont
hsofr
ecei
vi
ngART.

ThemeanHgbconcent
rat
ionwasi
ncr
easedandf
oundt
obe12.
8±1.
99g/
dlatt
hebase
l
i
neand14.
34±1.
89g/
dlaf
tersi
xmont
hsofART.

Regar
dingt
heRBCi
ndi
ces,basel
i
nemeanv
aluesofMCV,MCH,andMCHC wer
e86.
41±
42.
84f
l,29.
1±2.
69pg,
and33.
53±1.
73g/
dlr
espect
ivel
yandaf
ter6mont
hsofARTi
nit
iat
ion
wer
e96.
27±8.
96f
l,32.
78±4.
09pg,
and34.
14±1.
94g/
dl,
respect
ivel
y.Hgb,
MCV,
MCHand
MCHCwer
ehi
gheraf
ter6mont
hsofARTi
nit
iat
ioncompar
edt
othebasel
i
newhi
l
eRBC
countshoweddecr
ementi
nthei
rmeanv
alues.

Themeanpl
atel
etcountoft
hest
udypar
ti
cipant
swer
e223. 5×103/
8±110. μlatt
hebasel
i
ne
and

21
273. 2×103/
3±87. μlaf
ter6mont
hsofARTi
nit
iat
ion(
tabl
e4.
).

Tabl
e4:I
mmunohemat
ologi
calv
alues(
Mean±SD)ofHI
V posi
ti
veadul
tindi
vi
dual
sat
basel
i
neandaf
ter6mont
hsofARTatBi
shof
tuHospi
tal
ARTuni
t,Bi
shof
tu,
Oromi
a,
2021.

Par
amet
ers Bef
orei
nit
iat
ionofART Af
ter si
x mont
hs of
P-v
alue
ART
(
n=136)Mean±SD
I
nit
iat
ion(
n=)
Mean±
SD

WBC(
×103/
μl) 5.
52±2.
14 6.
19±2.
18 0.
000

RBC(
×106/
μl) 4.
41±0.
71 4.
28±0.
59 0.
009

ANC(
X103/μl
) 2.
99±1.
57 3.
25±1.
59 0.
000

Hgb(
g/dl
) 12.
8±1.
99 14.
34±1.
89 0.
000

MCV(
fl
) 86.
41±42.
84 96.
27±8.
96 0.
000

MCH(
pg) 29.
1±2.
69 32.
78±4.
09 0.
000

MCHC(
g/dl
) 33.
53±1.
73 34.
14±1.
94 0.
000

PLT(
×103/
μl) 223.
8±110.
5 273.
3±87.
2 0.
000

CD4(
Cel
l
s/μl
) 162.
5±108.
6 347±183.
17 0.
000

6.
4Pr
eval
enceofi
mmunohemat
ologi
calabnor
mal
it
ies
Hemat
ologi
calabnor
mal
i
tieswer
eobser
vedbot
hbef
oreandaf
tert
reat
mentwi
thART.
Commonhemat
ologi
calabnor
mal
i
tiesf
oundi
nthi
sst
udywer
epr
esent
edi
nFi
gur
e2.

22
Accor
dingl
y;l
eucopeni
a was seen i
n26.
7% and 16.
5%,neut
ropeni
a 16.
5% and 9.
4%,
l
ymphopeni
ain20% and3.
1% andt
hrombocy
topeni
ain25.
9% and7.
1% oft
hesubj
ect
s
bef
oreandaf
teri
nit
iat
ionofARTr
espect
ivel
y.

Fi
gur
e2:Pr
eval
enceofHemat
ologi
calabnor
mal
i
tiesandi
tsper
cent
ageofHI
VPosi
ti
ve
i
ndi
vi
dual
satbasel
i
neandaf
ter6mont
hsofARTatBi
shof
tuGener
alHospi
tal
,ARTuni
t,
Bi
shof
tu,
Oromi
a.

Anemi
awasf
oundi
n41.
9%ofsubj
ect
satt
hebasel
i
neand11.
4%oft
hesubj
ect
saf
terat
l
east6mont
hsofART(
Figur
e2)
.Amongt
heanemi
ccases,
themaj
ori
ti
eswer
emi
l
danemi
c
whi
chaccount
s84.
1% att
hebasel
i
neand75.
9% af
ter6mont
hsofART.Thi
sst
udyal
so
f
oundmoder
ateanemi
ain15.
9% oft
heanemi
ccasesatt
hebasel
i
neand24.
1% oft
he
anemi
ccasesaf
ter6mont
hsofART.Sev
ereanemi
awasnotf
oundi
nthi
sst
udy
.Fr
om t
otal
anemi
cpat
ient
satt
hebasel
i
ne,30.
6% oft
hesubj
ect
swer
eimpr
ovedf
rom anemi
a.The
r
esul
tshowedt
henumberofanemi
ccasesdecr
easedsi
gni
fi
cant
ly(
Figur
e3)
.

23
 Bef
oreART Mi
l
danemi
a Af
ter
ART
Mi
l
danemi
a
Moder
ateanemi
15.
9 Moder
ateanemi
24.
1 a

75.
9
84.
1

Fi
gur
e3.
Compar
isonoft
hesever
it
yofanemi
aandi
tsper
cent
ageofHI
Vposi
ti
vepat
ient
s
atbasel
i
neandaf
ter6mont
hsofARTatBi
shof
tuHospi
tal
,ARTuni
t.

24
 7.Di
scussi
on
Thi
sst
udyi
nvest
igat
edt
hehemat
ologi
calpr
ofi
l
esof136HI
Vposi
ti
vei
ndi
vi
dual
staki
ng
ARTf
ormor
ethansi
xmont
hsatARTcl
i
nicofBi
shof
tuGener
alHospi
talDet
ermi
nat
ionof
hemat
ologi
calpr
ofi
l
esamongHI
Vposi
ti
vepat
ient
sonARTwi
l
lhav
econt
ri
but
iont
owar
ds
under
standi
ngt
heef
fectoft
hedr
ugsondi
ff
erenthemat
ologi
cal
par
amet
ers.

Thest
udyhasf
oundt
hatsi
xmont
hsoft
reat
mentwi
thARTr
esul
tedi
nasi
gni
fi
cantand
f
avor
abl
echangei
nhemat
ologi
calpr
ofi
l
esofHI
Vposi
ti
vei
ndi
vi
dual
.Thehemat
ologi
cal
abnor
mal
i
tiesobser
vedbef
oreandaf
terART i
ncl
udeanemi
a,l
eucopeni
a,neut
ropeni
a,
l
ymphopeni
aandt
hrombocy
topeni
a.

Thi
sst
udyshowedt
hatt
hemean±SDwhi
tebl
oodcel
lcountatt
hebasel
i
newas5.
52
14×103/
±2. μlandaf
ter6mont
hsi
nit
iat
ionofHAART,i
tincr
easedt
o6. 18×103/
19±2. μl
(
Tabl
e4)
.

Leucopeni
awasf
oundt
obepr
esentbef
oreandaf
tert
reat
mentwi
thART.Thi
sst
udy
r
eveal
edt
hatt
hepr
eval
enceofl
eucopeni
awas26.
7% atbasel
i
neand16.
5% af
tersi
x
mont
hsofART(
tabl
e4)
.Absol
uteneut
rophi
lcount(
ANC)al
soshowedi
ncr
ement
saf
ter6
mont
hsofARTi
nit
iat
ion.

I
nthi
sst
udyt
hepr
eval
enceofneut
ropeni
awasf
oundt
obe16.
5%bef
orei
nit
iat
ionofART
and9.
4%af
ter6mont
hsofARTi
nit
iat
ion.Pat
ient
sonARTshowedsi
gni
fi
cantr
educt
ioni
n
t
he pr
eval
ence ofneut
ropeni
a compar
ed t
othei
rART-
nai
ve pat
ient
s.Si
mil
arl
y,t
he
pr
eval
enceofl
ymphopeni
ashowedsi
gni
fi
cantr
educt
ionaf
tersi
xmont
hsofART(
20%v
s
3.
1%)
,(t
abl
e4.
)

25
Thepr
esentst
udyr
eveal
edt
hat
CD4+Tcel
l
scountwer
eincr
easedf
rom 162.
5±108.
6
cel
l
s/μlt
o347±183.
17cel
l
s/μlaf
ter6mont
hini
ti
ati
onofART(
Tabl
e4)
.Thel
owerCD4
countatt
hebasel
i
nei
sduet
oHI
Vinf
ect
ion(
tabl
e4.
).

I
nthi
sst
udy
,themeanv
alueofRBC countwasl
oweraf
terARTi
nit
iat
iont
hanatt
he
basel
i
ne(
Tabl
e4)
.

Thepr
esentst
udyal
soshowedt
hathemogl
obi
nval
uewasi
ncr
easedaf
terARTi
nit
iat
ion.
Themeanv
aluesofhemogl
obi
nwer
e12.
8±1.
99g/
dlatt
hebasel
i
neand14.
34±1.
89g/
dl
af
tersi
xmont
hsofART(
Tabl
e3)
.

Si
gni
fi
cantdi
ff
erencewasobser
vedi
ntheRBC i
ndi
ces(
MCV,MCH andMCHC)af
ter
6mont
hsofARTi
nit
iat
ioncompar
edt
othebasel
i
ne(
tabl
e4)
.

Thepr
esentst
udyr
eveal
edt
hatt
hepr
eval
enceofanemi
aatt
hebasel
i
newas41.
9%wi
th
84.
1%mi
l
dand15.
9%moder
ateanemi
a.Af
tersi
xmont
hsofART,
thepr
eval
enceofanemi
a
wasr
educedt
o11.
4%(
Figur
e3.
).

I
nthepr
esentst
udypl
atel
etcountwasi
ncr
easedsi
gni
fi
cant
lyaf
ter6mont
hsoft
he
t
reat
ment(
Fig3)
.

Thi
sst
udyr
eveal
edt
hatt
hepr
eval
enceoft
hrombocy
topeni
awas25.
9% atbasel
i
neand
7.
1%af
tersi
xmont
hsofARTi
nit
iat
ion.

Gener
all
y,Ourr
esul
tfi
ndi
ngswer
e agr
eedwi
tht
hedi
ff
erentst
udi
esconduct
edont
he

26
Det
ermi
nat
ion ofhemat
ologi
caland i
mmunol
ogi
calpar
amet
ers among HI
V posi
ti
ve
pat
ient
staki
nghi
ghl
yact
iveant
ir
etr
ovi
ralt
reat
mentandt
reat
mentnaï
vei
ntheant
ir
etr
ovi
ral
t
her
apycl
i
nic ofGondarUni
ver
sit
yHospi
tal
,The Pr
eval
ence ofsome Hemat
ologi
cal
Abnor
mal
i
tiesamongHI
VPosi
ti
vePat
ient
sont
hei
rfi
rstv
isi
ttot
ert
iar
yHeal
thI
nst
it
uti
oni
n
Et
hiopi
aandHemat
ologi
calRel
atedDi
sor
der
sandt
ransf
usi
onofHI
Vpat
ient
sonHAARTi
n
sout
hwestr
egi
onofCamer
oonr
eveal
edsi
mil
arr
esul
ts.

8.Concl
usi
on
Basedont
her
esul
tsoft
hecur
rentst
udy
,thef
oll
owi
ngconcl
usi
onswer
emade.

 Ther
e was si
gni
fi
canti
ncr
ease i
n CD4+ T cel
lcount
,WBC count
,neut
rophi
l
,
l
ymphocy
te,hemogl
obi
n,MCV,MCH,MCHCandpl
atel
etsaf
tersi
xmont
hsofART
whi
l
ether
ewasadecr
easei
nthest
atusofr
edbl
oodcel
l
s(RBCs)countcompar
ed
t
obasel
i
ne.

 Anemi
a, l
eucopeni
a, neut
ropeni
a, l
ymphopeni
a and t
hrombocy
topeni
a wer
e
commonl
ypr
eval
enthemat
ologi
cabnor
mal
i
tiesencount
eredi
nwi
thHI
V/AI
DSand
al
so on ant
i-
ret
rov
iralt
her
apybutt
hepr
eval
ence of t
heabnor
mal
i
tieswer
e

27
 si
gni
fi
cant
lyr
educedaf
teri
nit
iat
ionofART.

 Theobser
veddi
ff
erencei
nhemat
ologi
calpr
ofi
l
esofHI
Vinf
ect
edi
ndi
vi
dual
swer
ein
l
i
newi
thal
ter
nat
ivehy
pot
hesi
s.

9.Li
mit
ati
onoft
hest
udy
 Lackofcompl
etei
nfor
mat
ion(
incompl
etenessoft
hedat
a)onsomehemat
ologi
cal
par
amet
ersatt
het
imeofARTi
nit
iat
ion.

 Thest
udyf
ocusedoncompar
isonsofhemat
ologi
calandi
mmunol
ogi
calpar
amet
ers
butdoesnotaddr
essesr
iskf
act
orsduet
ofi
nanci
alandot
herpr
obl
em.

 Thef
indi
ngoft
hepr
esentst
udywasbasedoncr
oss-
sect
ional
study
.

28
29
 10.Recommendat
ions
 Fur
therr
esear
chi
sneededonhemat
ologi
calpar
amet
ersi
ncl
udi
ngRet
icul
ocy
te
count
,monocy
tesandcoagul
ati
ont
est
s.

 Fur
theri
nvest
igat
ionneedst
obedonet
oident
if
ytheassoci
atedr
iskf
act
orsf
or
eachhemat
ologi
cal
abnor
mal
i
ty.

 TheEf
fectofuseofARTdur
ati
ononhemat
ologi
calpar
amet
ersneedst
obe
conf
ir
medbycohor
tst
udi
es.

 Lar
gescal
eandl
ongi
tudi
nalst
udi
esar
erecommendedt
oexpl
oret
hepr
obl
em i
n
dept
h.

30
 12.Ref
erence
1.Subst
ance Abuse Tr
eat
mentf
orPer
sons wi
th HI
V/AI
DS.Show det
ail
s Tr
eat
ment
I
mpr
ovementPr
otocol(
TIP)Ser
ies,No.37.
Cent
erf
orSubst
anceAbuseTr
eat
ment
.
Rockv
il
le(
MD)
:Subst
anceAbuseandMent
alHeal
thSer
vicesAdmi
nist
rat
ion(
US)
;2000.

2.ht
tps:
//canf
ar.
com/
awar
eness/
about
-hi
v-ai
ds/
hist
ory
-of
-hi
v-
aids/

3.ht
tps:
//en.
m.wi
ki
pedi
a.or
g/wi
ki
/Hi
stor
y_of
_HI
V/AI
DS

4.TheWHOCl
i
nical
Stagi
ngSy
stem f
orHI
V/AI
DS

Jenni
ferL.Wei
nber
gandCar
ri
eL.Kov
ari
k,MD

FourCl
i
nical
Stages

5.ht
tps:
//www.
hist
ory
.com/
topi
cs/
1980s/
hist
ory
-of
-ai
ds

December1st
,1988.

6.ht
tps:
//www.
aver
t.
org/
prof
essi
onal
s/hi
v-
sci
ence/
over
view

7.ht
tps:
//www.
aver
t.
org/
about
-hi
v-ai
ds/
how-
inf
ect
s-body

8.Hemat
ologi
calMani
fest
ati
onsi
nHI
VInf
ect
edPat
ient
sandCor
rel
ati
onwi
thCD4Count
s
andAnt
iRet
rov
iral
Ther
apySwat
iKat
hur
ia1,
Per
meetKaurBagga2,
Sit
aMal
hot
ra

9.Det
ermi
nat
ionofhemat
ologi
calandi
mmunol
ogi
calpar
amet
ersamongHI
V posi
ti
ve
pat
ient
staki
ng hi
ghl
y act
ive ant
ir
etr
ovi
ralt
reat
mentand t
reat
mentnaï
vei
nthe

31
 ant
ir
etr
ovi
ralt
her
apycl
i
nicofGondarUni
ver
sit
yHospi
tal
,Gondar
,Nor
thwestEt
hiopi
a:a
compar
ati
vecr
oss-
sect
ional
study

Baml
akuEnawgaw,
Meser
etAl
em,Zel
alem Addi
s&Mul
uget
aMel
ku

10.I
mmunol
ogi
cal
andHaemat
ologi
cal
Changesi
nHI
VInf
ect
ion

ByWanMaj
diahWanMohamad,WanSur
ianaWanAbRahman,Suhai
rAbbasAhmedAl
-
Sal
i
handCheMar
ainaCheHussi
n

Publ
i
shed:
Sept
ember2nd2015

11.Ast
udyoft
hehemat
ologi
calpr
ofi
l
eofhumani
mmunodef
ici
encyv
irusposi
ti
vepat
ient
s
i
ncoast
alSout
hIndi
anr
egi
on

Debar
shi
Saha,
Jyot
iRKi
ni,
Reshmi
Subr
amani
am

Depar
tmentofPat
hol
ogy
,KMC,
Mani
pal
Uni
ver
sit
y,Mangal
ore,
Kar
nat
aka,
Indi
a

Dat
eofWebPubl
i
cat
ion22-
Oct
-2015

12.Gender
-baseddi
ff
erencesi
nhemat
ologi
calandCd4+T-
ly
mphocy
tecount
samongHI
V-
pat
ient
sinI
do-
Eki
tiEsanAy
odel
eJacob

Depar
tmentofHemat
ologyandBl
oodTr
ansf
usi
onSci
ence,Feder
alTeachi
ngHospi
tal
,
Ni
ger
ia

Cor
respondence:EsanAy
odel
e Jacob,Hemat
ology and Bl
ood Tr
ansf
usi
on Sci
ence
Depar
tment
,Feder
alTeachi
ngHospi
tal
,I
do-
Eki
ti
,Ni
ger
ia

Recei
ved:
Nov
ember25,
2016|
Publ
i
shed:
Febr
uar
y20,
2017

13.ht
tps:
//www.
who.
int
/, 30/Nov
ember2020

14.HI
V/AI
DSAl
so cal
l
ed:Acqui
red i
mmunodef
ici
ency sy
ndr
ome,AI
DS,HI
V,Human
i
mmunodef
ici
encyv
irusMedl
i
nepl
us-
Treat
mentopt
ionsf
orHI
VTr
eat
mentshoul
dbegi
n
assoonaspossi
bleaf
teradi
agnosi
sofHI
V,r
egar
dlessofv
iral
load

ByWanMaj
diahWanMohamad,WanSur
ianaWanAbRahman,Suhai
rAbbasAhmedAl
-

32
 Sal
i
handCheMar
ainaCheHussi
n

Publ
i
shed:
Sept
ember2nd2015

15.AssessmentofHI
V-r
elat
ed st
igma and det
ermi
nant
s among peopl
eli
vi
ng wi
th
HI
V/AI
DSi
nAbeokut
a,Ni
ger
ia:
Acr
oss-
sect
ional
study

ht
tps:
//doi
.
org/
10.
1177%2F2050312119869109

16.pr
eval
enceofanemi
abef
oreandaf
teri
nit
iat
ionofhi
ghl
yact
iveant
ir
etr
ovi
ralt
her
apy
amonghi
vposi
ti
vepat
ient
sinnor
thwestet
hiopi
a:ar
etr
ospect
ivest
udy
"

Zel
alemTesf
ayeBaml
akuEnawgaw

17.Hemat
ologi
cal
abnor
mal
i
tiesi
near
lyandadv
ancedHI
Vinf
ect
ionpat
ient
s.,

M BhanuKumar
,TThi
ppesWamy
,RShankarCPr
athi
ma

18.hemat
ologi
caland cl
i
nicalpr
ofi
l
es ofHI
Vinf
ect
ed adul
tsi
nit
iat
ing HAART i
n
Uganda,
2015

19.det
ermi
nat
ionofhemat
ologi
calandi
mmunol
ogi
calpar
amet
ersamongHI
Vpat
ient
s
t
aki
ngHAARTandt
reat
mentnaï
vei
ntheARTcl
i
nicofGonder
.

20.pr
eval
encesomehemat
ologi
cal
abnor
mal
i
tiesamongHI
Vposi
ti
vepat
ient
sont
hei
rfi
rst
v
isi
ttoat
ert
iar
yheal
thi
nst
it
uti
oni
nEt
hiopi
a.

Zel
al s1,
em Addi GashewYi
t ew2,
ay andBel
ay e3j
neshTachebel uly
,2014

21.hemat
ologi
cal
abnor
mal
i
tiesi
nHI
Vinf
ect
edi
ndi
vi
dual
sincor
rel
ati
ont
oCD4count
sand
ARTst
atus.

asiRaman R1,DMani an2,G Hemanat

han3,Tameem Afoz4,Radha Sagar
5
Thul mar r
01/
12/
2015

33
 13.Annexes
13.
1Inf
ormat
ionsheet
Wear
eaGr
aduat
eyearst
udent
satRi
ftVal
l
eyUni
ver
sit
y,depar
tmentofMedi
calLabor
ator
y
Technol
ogy
.Wear
eher
etocar
ryoutar
esear
chonassessmentofhemat
ologi
calpr
ofi
l
es
amongHI
Vposi
ti
vei
ndi
vi
dual
sinf
ulf
il
lmentofourBSC.

Theobj
ect
iveoft
hisst
udyi
stoassesst
hehemat
ologi
calpr
ofi
l
esamongHI
Vposi
ti
ve
i
ndi
vi
dual
.Fort
hisst
udywewi
l
ltake3ml
ofv
enousbl
ood.Ther
eisnodi
rectbenef
ity
ouget
f
rom t
hist
hesi
s,buti
ndi
rect
lyt
heout
comeoft
her
esul
twi
l
lbeusedt
oimpr
ovet
hel
i
feof
ourHI
Vinf
ect
edi
ndi
vi
dual
saf
teri
nit
iat
ionofART,soy
ourpar
ti
cipat
ioni
shi
ghl
yfort
his
st
udy
.

Ther
iskoft
hispr
ojecti
s,y
ouf
eelami
l
dpai
nwhi
l
esampl
esar
ecol
l
ect
edexceptt
hatt
her
e
wi
l
lbenohar
medt
opar
ti
cipat
eint
hest
udy
.

Codi
ngmet
hodwi
l
lbeappl
i
edi
nal
lthepr
ocedur
es,
codewi
l
lbegi
vent
othequest
ionnai
re
f
orm andal
sot
obl
oodsampl
es,whi
chmeanst
hesamecodei
susedf
orbot
hbl
ood
sampl
eandl
abor
ator
yresul
tanddat
aisanal
yzedaccor
dingl
y,soy
ourr
esul
twi
l
lbekept
conf
ident
ial
,andal
sonooneknowsy
ourr
esul
t.

Ther
enot
hingy
ouwi
l
llossi
fyouar
enotwi
l
li
ngt
opar
ti
cipat
eint
hest
udyorst
opf
il
li
ngt
he
quest
ionnai
rei
nbet
ween,
soi
tisy
ourr
ightt
opar
ti
cipat
eornott
opar
ti
cipat
eint
hest
udy
.

Woul
dyoubewi
l
li
ngt
opar
ti
cipat
e?

Yes,
Iwantt
opar
ti
cipat
eint
hest
udy Pl
easegot
othenextpage

No,
Idon’
twantt
opar
ti
cipat
eint
hest
udy
. Thanky
ouv
erymuch!

I
fyouneedt
ohav
efur
theri
nfor
mat
ionori
fhav
erel
atedi
nfor
mat
ionont
hisst
udyy
oucan
cont
actRi
ftVal
l
eyUni
ver
sit
y,col
l
ageofHeal
th,
Depar
tmentofMedi
cal
Labor
ator
y.

34
 13.
1Fuul
aOdeef
fannoo(
Inf
ormat
ionsheetAf
anor
omov
ersi
on)

Nut
iaskanj
i
rrueebbi
famt
oot
abar
akanaay
uuni
var
sit
iiRi
ftVaal
i
iOgummaaMeedi
kaal
Laabor
atoor
ii
ti
.Nut
isbakkakanakandhuf
neefeebbadi
gri
ikeeny
aguut
tachuufqor
annoo
dhi
i
gaagosaaddaaddaanamoot
adhi
i
gai
saani
ikeessat
tiv
aay
irasi
iHI
V/AI
DSar
gamu
i
rr
att
igaggeessuudhaafdhuf
ne.

Kaay
yoonqor
annookanaasnamoot
adhi
i
gai
saani
ikeessat
tiv
aay
irasi
iHI
V/AI
DSar
gamu
i
rr
att
iiqor
annoogosadhi
i
gaaaddaaddaaadeemsi
suudha.Qor
annookanaafdhi
i
gami
l
il
it
ri
i
3nubar
baachi
sa.Qor
annookanai
rr
aasf
aay
idaankal
l
att
ii
dhaanat
iar
gat
tuhi
nji
ru.Gar
uual
-
kal
l
att
ii
dhaanbu’
aanqor
annookanaaj
i
reeny
anamoot
avaay
irasi
i
nHI
V/AI
DSdhi
i
gai
saani
i
keessat
tiar
gamuuf
ooy
yessuudhaafwaangar
gaar
uufhi
rmaannaankeeqor
annookanaaf
haal
aanbar
baachi
saadha.Mi
i
dhaan qor
annoo kanaan si
rr
a ga’
uyoo j
i
raat
e, y
eroo
saamuudif
udhat
amudhukkubbi
ixi
qqoosi
tt
idhaga’
amuqof
aadha.Kanai
rr
aakanhaf
e
waanqor
annookanakeessat
tihi
rmaat
teefmi
i
dhaani
nni
sir
raanga’
uhi
nji
ru

Tar
ti
iba hoj
i
ihundaat
ii
flakkoof
sa addaat
u kennamaaf
, l
akkof
siaddaa kun war
aqaa
gaaf
fi
it
iif
isaamudaaf l
akkoof
sa addaa walf
akkat
aat
u kennamaaf
.Kana j
echuun
saamudaaf
ibu’
aaqor
annoot
ii
flakkoof
saaddaawalf
akkaat
aat
ukennamaafj
echuudha.
Haal
a kanaan qor
annoon gaggeef
fama,kanaaf
uu bu’
aan qor
annoo keet
iii
cci
ti
idhaan

35
qabama.nami
bu’
aaqor
annookeet
iibeekuudanda’
uhi
nji
ruj
echuudha.

Qor
annookanakeessat
tihi
rmaachuudhaay
oobaat
teswant
isi
rr
aahi
r’
atut
okkoy
uuhi
nji
ru,
y
oogi
dduut
tiaddaankut
teef
igaaf
fi
isi
i
fdhi
yaat
eguut
uuy
oobaat
tesakkasuma.Kanaaf
uu
qor
annookanakeessat
tihi
rmaachuuf
ist
a’edhi
i
suudhaafmi
rgaguut
uuqabda.

Qor
annookanakeessat
tihi
rmaachuuff
edhaqabdaa?

Eey
yee,qor
annookanakeessat
tihi
rmaachuuff
edhaqaba. Gar
afuul
ait
tiaanut
ti
dar
bi.

l
akki
i
,qor
annookanakeessat
tihi
rmaachuuff
edhahi
nqabu. Baay
’eegal
atoomi
!

Odeef
fannoo bal
’
aa waa’
ee qor
annoo kanaa ar
gachuu y
oobar
baadde,Kol
l
eej
j
iiFay
yaa
y
uunuv
arsi
ti
iRi
ftVaal
l
iiDi
ppaar
tmant
iiMeedi
kaal
Laabor
aat
ori
iquunnamuuni
dandeessa.

13.
2ConsentFor
m.
Consentno._
___
___
___
___
___
___
___
__

I
nfor
mat
ion aboutt
he st
udy has been expl
ained t
o me by t
he i
nvest
igat
or.Ihav
e
under
stoodt
hatt
heobj
ect
iveoft
hisst
udyi
stoassesst
hehemat
ologi
calpr
ofi
l
esamong
HI
Vposi
ti
vei
ndi
vi
dual
sandsmal
lamountofbl
oodt
hatIgi
vewi
l
lnothur
tmyheal
th.I
thas
al
sobeenexpl
ainedt
omet
hatIhav
ether
ightt
ost
oppar
ti
cipat
ionatanyt
imei
nbet
ween
andt
her
eisnot
hing,
Iwi
l
llossi
fIr
efusepar
ti
cipat
e.

Iagr
eet
opar
ti
ci
pat
eint
hest
udyandher
ebyappr
ovemyagr
eementwi
thmysi
gnat
ure.

Par
ti
cipantsi
gnat
ure_
___
___
___
___
_Dat
e__
___
___
___
___
___
___
__

I
nvest
igat
orsi
gnat
ure_
___
___
___
___
_Dat
e__
___
___
___
___
___
___
__

Foor
mii
Wal
i
igal
tee.(
ConsentFor
m Af
anor
omov
ersi
on)

36
Lakk.
wal
i
igal
tee._
___
___
___
___
___
___
___
__

Odeef
fannoon waa’
ee qor
anni
chaa qor
ataadhaan naaf i
bsamee j
i
ra. Kaay
yoon
qor
anni
chaasi
bsahemat
ologi
calpr
ofi
l
edhukkubsat
aaHI
V AI
DSi
rr
att
iqabuqor
achuuf
akka t
a’e hubadheen j
i
ra.Dhi
i
ga xi
qqoo nami
i
dhuu hi
n dandeeny
e akka kennus nat
ti
hi
mameej
i
ra.Akkasumasy
eroonbar
baadet
timi
rgahi
rmannaakooaddaankut
uuakkan
danda’
uu f
isababa hi
rmannaa koo addaan kut
eef
is mi
i
dhaan nar
ra ga’
uu danda’
u,
kami
yyuuakkahi
nji
rr
enat
tihi
mameej
i
ra

Kanaaf
uuqor
annookanakeessat
tihi
rmaachuuff
edhakoot
ii
nwal
i
igal
eenj
i
ra.Wal
i
igal
uu
koot
ii
fimmoomal
l
att
ookoot
ii
nanmi
rkaneessa.

Mal
l
att
oohi
rmaat
aa _
___
___
___
___
_guy
yaa_
___
___
___

Mal
l
att
ooqor
ataa_
___
___
___
__¬¬_
___
__guy
yaa_
___
___
___
_

37
 14.Quest
ionnai
re

Quest
ionai
rei
dent
if
icat
ionNo_
___
___
___
__Si
te_
___
___
___
___
___
___
__Dat
e__
___
___

Par
t1.Soci
o-demogr
aphi
cchar
act
eri
sti
cs
No. Quest
ion Response Ski
pto Code
1 Age _
___
___i
nyear
s
2 Sex Mal
e Femal
e
3 Mar
it
alst
atus Si
ngl
e Di
vor
ced
Mar
ri
ed Wi
dowed
4 Et
hni
cit
y Or
oomo Ahmar
a
Ti
gre Gur
age
Ot
her
s(speci
fy)_
__
5 Rel
i
gion Or
thodox Pr
otest
ant
Musl
i
m Ot
her
s(speci
fy)_
_

6 Educat
ional I
ll
i
ter
ate Pr
imar
y
st
atus Hi
ghschool
Cer
ti
fi
cat
eandabov
e

7 Empl
oyment Empl
oyedi
npubl
i
cor
gani
zat
ion
st
atus Empl
oyedi
npr
ivat
eor
gani
zat
io
Sel
fempl
oyed
Unempl
oyed

1
2
Part 2. Basel
i
ne char
act
eri
sti
cs 0f subj
ect
s (
cli
nical
,labor
ator
y,and i
mmunol
ogi
cal
char
acter
ist
ics)
Cl
ini
calvar i
ablesatstartofART
N Quest ion Response Ski
pto Code
o.
8 Dat est art
ingofART ___
_/___
_/__
___
_
9 I sanydr ugt akenotherthanART Yes No ToQ10
10 Iftheanswert oQ9i st hety
peofdr
ugi
s
takenbysubj ect
sis/are
Valueofimmunol ogicalv ar
iablesatt hestar
tofART
12 CD4count
13 WBC
14 Neut r
ophil
15 Ly mphocy t
e
16 RBC
17 Hemogl obin
18 MCV
19 MCH
20 MCHC
22 Pl atel
ets
Part3.Char ecter
isti
cs t he subject s aft
erHAART tr
eat
mentCli
nicalv
ari
abl
es af
terART
tr
eatment
23 Forhow l ongdidt akeHAARTt reatment
24 Isthereanydr ugtakenot herthanART Yes No ToQ25
25 Iftheanswert oQ24i sy es,thet ypeof
dr
ugistakenbysubj ectsis/are
Val
uesofimmunohemat
ologi
cal
var
iabl
esaf
terHAARTt
reat
ment
26 CD4count
27 WBC
28 Neutrophil
29 Lymphocy te
30 RBC
31 Hemogl obi
n
32 MCV
33 MCH
34 MCHC
36 Plat
elets

3
Thanky
ouv
erymuchf
ort
aki
ngt
oanswert
hesequest
ions.Appr
eci
atey
ourcooper
ati
on!

14.Gaaf
fi
i(Quest
ionnai
reAf
anor
omov
ersi
on)

Lak.
Addaagaaf
fi
i.
___
___
___Bakka.
___
___
___
___
___
__Guy
yaagaaf
atame_
__/
___
__/
2013

Kut
aa1.Haal
amaal
ummaahawaasi
chaa
Lakk. Gaaf
fi
i Deebi
i dar
bi Lakk.
addaa
1 Umr
ii _
___
___waggaadhaan
2 Saal
a dhi
i
ra dhal
aa
3 Haal
agaa’
i
la Kanhi
nfuune/
heer
umne
Kanhi
ke/
hii
kte
Kanf
uudhe/
heer
umt
e
Kani
rr
aadu’
e/duut
e
4 Sabummaa Or
omoo Amaar
a
Ti
gree Gur
aagee
Kanbi
roo(
ibsi
)__
___
___
___
__
5 Amant
aa Or
todoksi
i Pr
otest
aant
ii
Musl
i
ma Kanbi
roo(
ibsi
)__
_

6 Haal
abar
noot
aa Kanhi
nbar
ati
n
Bar
umsasad.j
alqabaa
Bar
umsasad.2f
faa
Bar
umsasad.kol
l
eej
j
ii

7 Haal
ahoj
i
i Hoj
j
etaadhaabbat
amoot
ummaa
Hoj
j
etaadhaabbat
adhuunf
aa
Hoj
j
etaahoj
i
idhuunf
aa
Hoj
i
ikanhi
nqabne.

4
kut
aa2.Haal
aamal
ajal
qabbi
i(cl
i
nical
,labor
ator
y,f
iimmunol
ogi
i)Cl
i
nicalv
ari
abl
esatst
artof
ART
l
akk. Gaaf
fi
i Deebi
i dar
bi Lak.Addaa
8 Qor
ichay
oom j
alqabde? _
___
/__
__/
___
___
9 Qor
ichaHI
Val
akanbi
rof
udhat
tee? eey
yee Gar
a
l
akki
i gaaf
.10
10 Yoo deebi
i
nlakk.9 ey
yee t
a’e gosa
qor
ichaf
udhat
amebar
reessi

Hammabaay
’nagosoot
aimmunol
ogi
kaal
a.
12 Baay
’i
naCD4
13 Baay
’nagosadhi
i
gaAdi
i
14 Baay
’naNeut
rophi
l
15 Baay
i’
naLy
mphocy
te
16 Baay
inagosadhi
i
gaDi
i
maa
17 Baay
’i
naHemogl
obi
ni
18 Baay
’i
naMCV
19 Baay
’i
naMCH
20 Baay
’i
naMCHC
21 Baay
’i
naRDW
22 Baay
’i
naPl
atel
ets
kut
aa3.Amal
oot
aqor
annooer
gaqor
ichaj
alqabani
iboodaHaal
adhukkubi
chaqor
ichabooda
23 Yer
oohammami
i
fqor
ichaf
udhat
te
24 Qor
icha HI
Vti
i
n al
a qor
icha bi
ro eey
yee Gar
a gaaf
f
udhat
te? l
akki
i 25
25 Yoo deebi
i
nlakk.24 ey
yeet
a’egosa
qor
ichaf
udhat
amebar
reessi

5
Hammabaay
’nagosoot
aimmunol
ogi
kaal
aqor
ichabooda.
26 Baay
’i
naCD4
27 Baay
’nagosadhi
i
gaAdi
i
28 Baay
’naNeut
rophi
l
29 Baay
i’
naLy
mphocy
te
30 Baay
inagosadhi
i
gaDi
i
maa
31 Baay
’i
naHemogl
obi
ni
32 Baay
’i
naMCV
33 Baay
’i
naMCH
34 Baay
’i
naMCHC
35 Baay
’i
naRDW
36 Baay
’i
naPl
atel
ets
Gaaf
fi
ikoo xumur
eer
a.Yer
oo keenaafkenni
tee gaaf
fi
ideebi
suu keet
ii
fbaay
’een si
gal
ateef
fadha.