IMMUNOPHENOTYPE AND HEPATO-BIOMARKER CHARACTERISTICS OF HIV INFECTED ADULTS AND HEMATOLOGICAL REFERENCE RANGES OF CHILDREN IN KISUMU WEST SUBCOUNTY, KENYA

Abstract

Proper diagnosis and management of clinical diseases requires succinct understanding of well-established human physiological reference values. Despite the high prevalence rates of HIV, Tuberculosis and Hepatitis infection in Kisumu area of Western Kenya, there are no locally developedhematological values that can be used as reference values of normal biological or homeostatic processes from which pathogenic, pathologic or pharmacologic responses to a therapeutic intervention can be inferred. This study enrolled 1566 study participants(1509 healthy children for hematological reference range and 57 HIV positive, anti-retroviral therapy naive adults for immunophenotypic and hepato-biomarker characterization.Statistical analysis was done by graphpad by use of percentiles, Mann-Whitney test, Spearman’s correlation and Kruskall Wallis. The results of the study showed that it was possible to establish hematology reference ranges in children below two years and based on gender. It was notedthat the total white blood cell counts, monocyte andgranulocyte absolute counts in 1m to 6m age groups were statistically significantly lower than the other two age groups (p<0.001). In 1m to 6m age group, it was noted that the median values of hemoglobin, hematocrit and the RBC indices are higher compared to the age groups 6m to 12m and 12m to 17m (p<0.0001). For MCHC, the values were noted to be decreasing with increasing age and this was different in all the three age groups (p<0.0001). For platelets counts, the values were significantly different in all the three age categories with lower values in the lowest age category (1m to 6m) and higher values in the 6mto 12m age category (p<0.001). In regard to gender differences, hemoglobin values in females in 1m to 6m age group were significantly higher than the male children (p=0.0189). Platelet counts in females in 1m to 6m age group were significantly higher than the male children (p=0.0005). The median values for RBC indices for females were higher compared to males (p<0.0001). In comparison to the US/European reference ranges, we observed higher ranges of WBCs, absolute lymphocyte and monocyte counts. Wider ranges were observed in platelet counts in children from Kisumu West compared to the US/Europe ranges. Compared to Harriet Lane Handbook, higher counts were observed in WBC counts, lymphocyte counts and monocyte counts in the study. Wider values were noted in RBC, platelets and RDW, while lower ranges were noted in the current study for hemoglobin, hematocrit and granulocyte counts. Median ALT values in Hepatitis C positive HIV positive ART Naive participants were higher than in the Hepatitis C negative participants (p=0.0494). These hematology reference ranges results in the different age categories and in relation to gender underscore the importance of using locally derived hematological reference ranges for proper inclusion and exclusions of participants into clinical trials. The study also underscores the need for monitoring liver enzymes levels in ART naive HIV positive patients as well, screening for viral hepatitis before initiation of Anti-Retro Viral therapy as these diseasespathologically alters the body’s immune biomarkers.