Johns Hopkins POC-IT: Point of Care Information Technology [Home]
HIV Guide
 Zambia HIV National Guidelines
 


Introduction  

HIV Counseling and Testing  

Sexually Transmitted Infections (STIs)  

General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Diagnosis>Organ System>
HIV Guide Home PageEmail this module to a friend

Neutropenia

Richard D. Moore, M.D.
10-08-2009

Zambia Specific Information

  • Normal range of absolute neutrophil count (ANC) lower among people of African descent (approx. 800 - 4000).
  • Diagnose neutropenia with absolute neutrophil count (ANC) <500 (ACTG stage 3). 
  • Neutropenia common with AZT (5% during first year), usually develops early and may resolve without intervention.
  • Major cause is AZT. Also consider TB, lymphoma (if pancytopenia), other OIs, and advanced HIV (CD4 <50).
  • Assess for TB, other OIs
  • If on AZT, consider switch to alternative agent ( d4T, TDF).

REFERENCES

Zambia Information Author: Christopher Hoffmann, MD, MPH

CLINICAL

  • Multiple causes, including HIV infection, inflammatory cytokines, drugs (AZT, ganciclovir, foscarnet, amphotericin, flucytosine, sulfonamides, pyrimethamine, pentamidine, interferon-alfa), OIs with bone marrow replacement, chemotherapy for malignancy.
  • HIV can cause decreased growth of progenitor cell, CFU-GM; decreased endogenous G-CSF.
  • Prevalence ranges from 10% in asymptomatic HIV, 40-50% with AIDS.
  • Increased risk of bacterial and fungal infection with absolute neutrophil count (ANC) <750, but absolute risk relatively low. Greatest risk for infection and hospitalization with ANC <500.
  • Neutropenia (< 1000) not associated with decreased survival in HIV+ women (possibly in men, but not studied)

DIAGNOSIS

  • ANC <1000.
  • Anemia often present when caused by HIV infection, drugs, or OIs

TREATMENT

Treatment of neutropenia

  • Assess for reversible causes requiring specific treatment, such as modifying use or dose of causative drug.
  • Consider treatment with growth factors for ANC <500 (increased risk, but absolute risk for infection low).
  • G-CSF: (filgrastim) Initial dose of 5 mcg/kg (or 300 mcg = "1" cc) SC once-daily: titrate as necessary after 1 wk by adjusting dosing interval to every other day, 3x/wk, 2x/wk. Can also reduce dose (e.g. 150 mcg, 75 mcg, etc.) Goal is to maintain ANC >1000-2000.
  • GM-CSF: (sargramostim) Initial dose of 250mcg/m2 once-daily; titrate as necessary by adjusting dosing interval as with G-CSF.
  • Pegylated G-CSF (pegfilgrastim) 6 mg SQ weekly or less
  • Monitor ANC during G-CSF and GM-CSF 1-2x/wk.
  • Adverse effects of growth factors: Pain at injection site, myalgias, bone pain, low-grade fever, fatigue, flu-like symptoms, possible elevated lactic dehydrogenase and alkaline phosphatase. No evidence of adverse effect on HIV replication.
  • USPHS/IDSA guidelines: G-CSF and GM-CSF "not routinely indicated" for neutropenic HIV+ pts.
  • ART improves neutropenia in women (probably in men, but not studied)

Drug Comments

DrugRecommendations/Comments
G-CSF Would only consider for ANC <500. Otherwise, absolute risk of bacterial infection is low unless due to cancer chemotherapy or other drug-induced rapid decrease in ANC, and G-CSF not routinely indicated.

REFERENCES

REFERENCED WITHIN THIS GUIDE


 
Diagnosis
 


Complications of Therapy


Malignancies


Miscellaneous


Opportunistic Infections


Organ System

Drugs
 


Antimicrobial Agents


Antiretrovirals


Miscellaneous

Guidelines
 


Zambia HIV National Guidelines

Management
 


Antiretroviral Therapy


Laboratory Testing


Miscellaneous

Pathogens
 


Bacteria


Fungi


Parasites


Viruses

View All Modules
 
Index
 
 
Contacts    Help    Copyright    Acknowledgments    Abbreviations