Prevalence, patterns of cytopenia, and its associated risk factors among HIV-positive adults on HAART at ART follow-up clinics in Dawuro Zone public hospitals, Dawuro, Ethiopia, 2025. Multi-center-based cross-sectional study

Background Cytopenia, defined as a critical reduction in one or more hematopoietic lineages, remains the most prevalent immuno-hematological complication among HIV-infected individuals. Its multifactorial etiology involves direct viral suppression of the bone marrow, secondary opportunistic infections, and the adverse effects of Highly Active Antiretroviral Therapy (HAART). Clinically, cytopenias are associated with accelerated disease progression, suboptimal therapeutic response, and increased morbidity. Despite these significant health implications, there is a paucity of data regarding the prevalence, patterns, and associated risk factors of cytopenia among HIV-positive adults on HAART in the Dawuro Zone of Ethiopia. Objective To assess the prevalence, patterns, and associated risk factors of cytopenia among HIV-positive adults on HAART in ART follow-up clinics in the Dawuro Zone public hospitals. Method A multi-center, cross-sectional study was conducted from March 1 to April 30, 2025, across three public hospitals in the Dawuro Zone [i.e., Tercha General Hospital, Tocha Primary Hospital, and Gessa Primary Hospital], Ethiopia. Eligible participants were recruited from HIV patients on HAART at the follow-up clinics who were randomly selected until the target sample size of 231 was achieved. The study aimed to determine the prevalence and pattern of cytopenia using plain and ethylene diamine tetra-acetic acid (EDTA) for CBC analysis as per the WHO definition of hematologic abnormalities. In addition, cytopenia-associated risk factors like sociodemographic, clinical, nutritional, medication, behavioral factors, comorbidities, and the presence of opportunistic infections were assessed via interviewer-administered structured questionnaires. Univariate analyses were performed to establish the prevalence of cytopenia. Potential risk factors were examined using bivariate logistic regression at a 95% confidence interval (p < 0.25), with significant variables subsequently entered into a multivariate binary logistic regression model for statistical adjustment using SPSS v27, intending for statistical adjustment. Result The study included 231 participants with response rates of 230 (99.6%). The prevalence of cytopenia was 64 (27.8%), of which 34 (14.8%) were unicytopenia, 23 (10%) had bi-cytopenia, and only 7 (3%) had pancytopenia. In multivariate analysis, cytopenia was significantly associated with age > 50 years (AOR = 5.1, 95% CI: 1.3–2.1, P = .023), male gender (AOR = 2.8, 95% CI: 1.2–6.5, P = .014), bedridden patients (AOR = 6.0, 95% CI: 1.31–27.2, P = .02), having opportunistic infection (AOR = 4.57, 95% CI: 1.1–18.4, P = .032), LPV/r-based ART regimen (AOR = 6.06, 95% CI: 1.1–26.6, P = 0.02), poor drug adherence (AOR = 6.97, 95% CI: 2.9–16.6, P = 0.0), and participants with a CD4 count < 200 cells/mm 3 and 200–499 cells/mm 3 at AOR = 3.5 and 3.4; p = 0.04 and 0.023, respectively. Conclusion and recommendation In this study, the prevalence of cytopenia among adult HIV-positive adults was 27.8%, indicating a moderate burden. Male gender, older age, bedridden patients, opportunistic infections, LPV/r-based regimens, poor drug adherence, and CD4 counts below 499 cells/mm 3 were significant associations with cytopenia. The routine and frequent CBC tests, and adequate adherence counseling before HAART and during follow-up time, may improve cytopenia among HIV-positive adults.