Low burden of clinically relevant anaemia and thrombocytopenia among adolescents living with HIV receiving tenofovir/lamivudine plus dolutegravir: the CIPHER-ADOLA study in Cameroon.

BACKGROUND

Anaemia and thrombocytopenia adversely affect adolescent HIV outcomes, yet adolescent-specific data from the tenofovir/lamivudine/dolutegravir (TLD) era remain scarce, and access to full blood count (FBC) testing is limited in Cameroon. We evaluated the prevalence, severity, and factors associated with these cytopenias among adolescents living with HIV (ADLHIV) in the TLD era.

METHODS

Multicentre cross-sectional study was conducted among ADLHIV (10-19 years) receiving TLD in the CIPHER-ADOLA cohort in Cameroon. Full blood count, viral load (VL) and CD4-count were performed. Factors associated with anaemia and thrombocytopenia were ascertained.

RESULTS

A total of 252 ADLHIV was enrolled (50.8% male, 83.3% were vertically infected, and 7.2% were underweighted). ART-duration and TLD-exposure were 10 [6-13] years and 26 [12-33] months, respectively. Concerning virological response, 71.4%, 13.1%, and 15.5% had a VL < 50, 50-999, and ≥ 1000, respectively. Overall, 102 (40.5%) were anaemic, with only 2.9% severe. Anaemia rate was twice higher in females (55.6%, p < 0.001); 64.1% with VL ≥ 1000 against 35.0% with VL < 50 (p = 0.003); 60.0% with CD4 < 200 against 35.4% with CD4 > 500 (p = 0.046). Regarding thrombocytopenia, the burden was low (6.7%), but higher among VL ≥ 1000 (p = 0.003). Multivariate analyses showed a threefold higher anaemia prevalence in females (aOR [95% CI: 3.406 [1.8952-5.940]), fivefold without formal education (0.191 [0.047-0.776]), threefold in VL ≥ 1000 copies/ml (0.338 [0.156-0.733]). Thrombocytopenia was fourfold more likely in males (aOR: 0.236 [0.072-0.774]) and sevenfold more likely in individuals with VL ≥ 1000 copies/mL (aOR: 0.140 [0.038-0.510]).

CONCLUSION

In the TLD era, anaemia remains common but generally mild, and thrombocytopenia is uncommon. Cytopenias were associated with unsuppressed viral load, with a stronger association for anaemia in females. These findings support programmatic targeted haemovigilance prioritising adolescents with unsuppressed viral load, particularly females, in settings where access to FBC testing is limited.