Can haemoglobin estimation be used instead of cd4 counts to monitor hiv disease progression in resource limited setting

Background: At the end of 2008, 3 people out of 1000 between 15 to 49 years of age were affected with HIV in India. Commonly used prognostic markers like CD4 count and viral loads for HIV monitoring are expensive and sophisticated. Anemia is a frequent complication that occurs in 20-80% of HIV infected persons and is associated with faster disease progression and mortality. Therefore we aimed to determine the changes in Hb concentration and its correlation with CD4 counts and also to determine whether Hb alone can be used as an indicator for disease progression. Materials and Methods: 2 ml of venous blood was drawn for CD4 cell count and Hb% once monthly for a period of 3 months from 100 patients between the age of 18 to 60 years attending the Antiretroviral therapy (ART) Centre of our hospital. The results were compiled and descriptive and inferential statistical analyses done Results: Of the 100 patients majority of patients had CD4 counts above 200 and most had hemoglobin more than 12g/dl i.e. 63% while anemia was found in 37%. Over 3 months, out of the patients who had anemia, majority had CD4 counts below 500 and also, CD4 count was found to be less in people having Hemoglobin less than 12g/dl. Conclusion: Hemoglobin concentration is directly related to the number of CD4 cells. Measuring CD4 counts using flow cytometry is an expensive technique and as per guidelines is being repeated once in 6 months. Hence the Hb concentration, which is easy to estimate and can be done frequently may be used as a prognostic indicator in resource limited setting.