The normal reference range for blood haemoglobin was 12.0-18.0 g/dl and that of blood haematocrit was 37-55%. Blood was drawn for CD4 cell count, blood haemoglobin, blood haematocrit and Red cell indices. After obtaining consent, demographic questionnaires were completed. All patients enrolling in the study completed a written informed consent form in accordance with the Helsinki Declaration. This study was approved by the Committee on Human Research, Publications and Ethics (CHRPE), School of Medical Sciences, Kwame Nkrumah University of Science & Technology (KNUST), Kumasi. Blood samples were taken from the subjects before the initiation of ART.

The study was conducted between August 2007 and May 2008.

This study was a prospective case control comparative study which was conducted at one of the established centers providing Anti Retroviral Therapy (ART) and is located at Cape Coast, the capital of the Central region of Ghana. In addition, we sought to investigate the relationship between haemoglobin and CD4 lymphocyte count in the HIV individuals. We sought to compare the change in haemoglobin levels in the patients as the disease progressed to a Control group who were one hundred (100) sex- and age-matched healthy, HIV-seronegative individuals. The aim of this study was, therefore, to determine if blood haemoglobin measurement could be used as an indicator for the progression of HIV/AIDS in limited resource-limited settings. While racial variation in normal haemoglobin ranges and the side effects of antiretroviral agents such as zidovudine on the HIV infected bone marrow must be taken into account, monitoring haemoglobin levels shows utility in predicting disease progression both before and following HAART initiation. There have been suggestions that increases in haemoglobin are predictive of treatment success. Rates of haemoglobin decrease also correlate with falling CD4 counts. Haemoglobin levels reflect rapidity of disease progression rates and independently predict prognosis across demographically diverse cohorts. Markers investigated for their utility as simple markers for disease progression in resource-limited settings include delayed type hypersensitivity responses (DTH), total lymphocyte count (TLC), haemoglobin and body mass index (BMI). While CD4 count and HIV-RNA are the gold standard markers for disease monitoring in PLWHAs, when measurement of these parameters is not possible surrogate markers become important. Anaemia has been associated with progression to AIDS and shorter survival times for HIV-infected patients. Other mechanisms for HIV-associated anaemia, although uncommon, include vitamin B12 deficiency and the autoimmune destruction of red blood cells. HIV infection may lead to anemia in many ways: changes in cytokine production with subsequent effects on hematopoiesis decreased erythropoietin concentrations opportunistic infectious agents, such as Mycobacterium avium complex and parvovirus B- administration of chemotherapeutic agents such as zidovudine, ganciclovir, and trimethoprimsulfamethoxazole and myelophthisis caused by cancers such as lymphosarcoma. Therefore, interventions to prevent anaemia may lead to improved health and survival potential of HIV-infected persons.

This makes it more common than thrombocytopenia or leucopenia in patients with AIDS. Anaemia is a frequent complication that occurs in 20-80% of HIV-infected persons and is associated with faster disease progression and mortality. At the end of 2007, 40 million persons worldwide were living with HIV or AIDS. HIV infection is the chief cause of morbidity and mortality among adults and children, especially in sub-Saharan Africa.

Low hematocrit and hemoglobin in hiv