Eosinophilia and associated factors in a large cohort of patients infected with human immunodeficiency virus.

OBJECTIVES: To determine the prevalence of eosinophilia among antiretroviral therapy (ART)-naïve patients infected with human immunodeficiency virus (HIV) and to identify variables associated with eosinophilia. METHODS: We included all ART-naïve HIV-infected patients entering into care at the Thomas Street Health Center (Houston, Texas) between February 2007 and January 2009. Eosinophilia was defined as absolute eosinophil count ≥ 400 cells per cubic millimeter. Patients with eosinophilia (cases) at baseline were matched to patients without baseline eosinophilia (controls). Clinical and laboratory data were collected for cases and controls. Variables associated with eosinophilia were evaluated by univariate and multivariate analyses. RESULTS: Sixty-five (9.7%) of 671 ART-naïve patients had eosinophilia. There was no difference in age, sex, race, or baseline CD4 count between patients with and without eosinophilia; however, patients with eosinophilia were more likely to have higher HIV RNA viral loads (5.05 vs 4.82 log10 copies per milliliter; P = 0.019). A total of 52 (80%) of 65 patients with eosinophilia (cases) had at least two follow-up clinic visits. They were matched to 104 controls. Skin rash was the only variable associated with eosinophilia (odds ratio 2.16, 95% confidence interval 1.04-4.47) in our multivariate analysis. Of eight cases tested, only one, from Central America, had a parasitic infection (hookworm). Thirty-eight (73.1%) patients experienced resolution of their eosinophilia by the end of the study (mean follow-up 1019 days). Resolution of eosinophilia did not differ between patients with and without HIV viral suppression. CONCLUSIONS: Eosinophilia is not an infrequent occurrence among ART-naïve HIV-infected patients. Patients with eosinophilia are more likely than patients without eosinophilia to present with a skin rash. HIV RNA viral suppression did not necessarily result in the resolution of eosinophilia. Extensive workup for eosinophilia may not be necessary in most cases.

Prevalence of G6PD deficiency in a large cohort of HIV-infected patients.

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect. Screening for this condition in HIV-infected patients from susceptible ethnic groups is recommended based on expert opinion. Here we determined the prevalence of G6PD deficiency and the occurrence of G6PD-related hemolytic events in a large cohort of patients. METHODS: We identified all HIV-infected adults who presented as new patients at a single urban HIV clinic between 02/01/2007 and 01/31/2009. Demographic and laboratory data including G6PD results were collected. In addition, outpatient and inpatient medical records of G6PD deficient patients were reviewed for episodes of hemolytic anemia. RESULTS: A total of 1172 patients were identified and G6PD testing was performed in 1110 (94.7%). Overall, 75 (6.8%) subjects had G6PD deficiency. Rates were higher among African Americans (68/699; 9.7%) and Hispanics (5/253; 2.0%). Only one non-Hispanic White subject had G6PD deficiency (1/153; 0.7%). At baseline, hemoglobin concentrations were similar among subjects with or without G6PD deficiency. Among patients with G6PD deficiency, 40 (53.3%) were prescribed trimethoprim-sulfamethoxazole or dapsone. During follow-up, five (6.7%) of these patients developed acute hemolytic anemia. DISCUSSION: These results provide strong clinical evidence for recommending G6PD testing in HIV-infected subjects from susceptible ethnic backgrounds.