EVALUATION OF SERUM COBALAMIN LEVEL AMONG HUMAN IMMUNODEFICIENCY VIRUS (HIV)- INFECTED NIGERIANS WITH ANAEMIA AT UNIVERSITY OF BENIN TEACHING HOSPITAL (UBTH), BENIN CITY

Abstract

Background: Human immunodeficiency virus (HIV) is the virus that causes AIDS
with affectation of multi organ systems including Haemopoietic stem cell and
ultimately Haemopoiesis. Anaemia is the most common haematological complication
seen in HIV infection. The anaemia of HIV infection is multifactorial. Vitamin B12
deficiency has been implicated as a cause of anaemia in HIV disease.
Objective: The objective of this study was to determine the prevalence of
cobalamin deficiency among antiretroviral therapy (ART)-naive HIV-infected patients
with anaemia at the University of Benin Teaching Hospital, Benin City.
Materials and method: Three categories of participants were recruited for this
study after giving consent: 126 ART-naive HIV-positive patients with anaemia (test
group), 54 HIV-negative patients with anaemia (control group) and 41 apparently
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healthy individuals who were non-anaemic and HIV negative (apparently healthy
group). Five millilitres (5mls) of blood samples were obtained from each of the
enrolled subjects. Assay for serum methylmalonic acid (MMA) levels (an indirect
measure of vitamin B12 level) was carried out by Enzyme linked Immunosorbent
assay (ELISA) method using Human methylmalonic acid ELISA kit (catalog number
E2091h).
Full blood count, along with red cell indices were determined in test and control
groups using haematology auto analyser. CD4 count were done only on HIV-infected
subjects using cyflowmeter (Cyflow partec). Stool microscopy, reticulocyte count and
blood film were carried out only on ART-naïve HIV-infected subjects found to have
high methylmalonic acid level. Only haemoglobin and MMA levels were carried out
on apparently healthy individuals who were non-anaemic and HIV-negative.
Result: Two hundred and twenty one participants comprising 126 ART-naïve HIV
infected patients with anaemia, 54 HIV-negative anaemic subjects and 41 apparently
healthy non-anaemic HIV-negative subjects aged between 18 and 60 years were
studied. Prevalence of cobalamin deficiency was found to be significantly higher
among ART-naïve HIV-positive anaemic patients (64.3%) (indicated by elevated
MMA level >0.59ng/ml which is the upper limit of the reference range gotten from
apparently healthy subjects who were non-anaemic and HIV negative) compared to
HIV-negative anaemic patients (5.6%) (p=0.001). There was a negative correlation
between CD4 count and MMA (r= -0.327) (p= 0.171), though not statistically
significant. Mean haemoglobin for test group is 9.0±1.5g/dl while that of the control
group is 10.49±0.8g/dl (p= 0.237). Mean WBC count for the test group is 4.6±1.2 x
109/l while that of the control group is 4.7±1.1 x 109/l (p= 0.252). Mean lymphocyte
count for the test group is 1.9±0.7 x 109/l while that of the control group is 1.94±
0.61 x 109/l (p= 0.788). Mean platelet count for the test group is 239±87 x 109/l
while that of the control group is 260±77 x 109/l (p= 0.435). Blood film showed
macrocytosis in 42% (34/81), normocytic red cells in 53.1% (43/81) and microcytic
red cells in 4.9% (4/81). Stool microscopy done showed that 13.6% (11/81) had
intestinal parasites. Ova of Ascaris lumbricoides were seen in 8.6% (7/81) while ova
of hookworm were seen in 4.9% (4/81).
Conclusion: HIV-infection is associated with cobalamin deficiency and so contribute
significantly to anaemia of HIV infection. Routine parenteral administration of
cobalamin to HIV-infected patients may help to reduce the prevalence of anaemia,
especially in places where assay may not be readily available, and so improve the
quality of life of the affected individuals.

EVALUATION OF SERUM COBALAMIN LEVEL AMONG HUMAN IMMUNODEFICIENCY VIRUS (HIV)- INFECTED NIGERIANS WITH ANAEMIA AT UNIVERSITY OF BENIN TEACHING HOSPITAL (UBTH), BENIN CITY