Anemia among HIV-Infected Patients Initiating Antiretroviral Therapy in South Africa: Improvement in Hemoglobin regardless of Degree of Immunosuppression and the Initiating ART Regimen

Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 H...

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Published inJournal of Tropical Medicine Vol. 2013; no. 2013; pp. 23 - 28
Main Authors Fox, Matthew P., MacPhail, A. Patrick, Sanne, Ian, Brennan, Alana T., Maskew, Mhairi, Takuva, Simbarashe
Format Journal Article
LanguageEnglish
Published Cairo, Egypt Hindawi Limiteds 01.01.2013
Hindawi Puplishing Corporation
Hindawi Publishing Corporation
John Wiley & Sons, Inc
Hindawi Limited
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Abstract Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 HIV-infected adults initiating first-line ART between April 2004 and August 2009 in Johannesburg, South Africa. The prevalence of anemia at ART initiation was 25.8%. Mean hemoglobin increased independent of baseline CD4. Females, lower BMI, WHO stage III/IV, lower CD4 count, and zidovudine use were associated with increased risk of developing anemia during follow-up. After initiation of ART, hemoglobin improved, regardless of regimen type and the degree of immunosuppression. Between 0 and 6 months on ART, the magnitude of hemoglobin increase was linearly related to CD4 count. However, between 6 and 24 months on ART, hemoglobin levels showed a sustained overall increase, the magnitude of which was similar regardless of baseline CD4 level. This increase in hemoglobin was seen even among patients on zidovudine containing regimens. Since low hemoglobin is an established adverse prognostic marker, prompt identification of anemia may result in improved morbidity and mortality of patients initiating ART.
AbstractList Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 HIV-infected adults initiating first-line ART between April 2004 and August 2009 in Johannesburg, South Africa. The prevalence of anemia at ART initiation was 25.8%. Mean hemoglobin increased independent of baseline CD4. Females, lower BMI, WHO stage III/IV, lower CD4 count, and zidovudine use were associated with increased risk of developing anemia during follow-up. After initiation of ART, hemoglobin improved, regardless of regimen type and the degree of immunosuppression. Between 0 and 6 months on ART, the magnitude of hemoglobin increase was linearly related to CD4 count. However, between 6 and 24 months on ART, hemoglobin levels showed a sustained overall increase, the magnitude of which was similar regardless of baseline CD4 level. This increase in hemoglobin was seen even among patients on zidovudine containing regimens. Since low hemoglobin is an established adverse prognostic marker, prompt identification of anemia may result in improved morbidity and mortality of patients initiating ART.
Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 HIV-infected adults initiating first-line ART between April 2004 and August 2009 in Johannesburg, South Africa. The prevalence of anemia at ART initiation was 25.8%. Mean hemoglobin increased independent of baseline CD4. Females, lower BMI, WHO stage III/IV, lower CD4 count, and zidovudine use were associated with increased risk of developing anemia during follow-up. After initiation of ART, hemoglobin improved, regardless of regimen type and the degree of immunosuppression. Between 0 and 6 months on ART, the magnitude of hemoglobin increase was linearly related to CD4 count. However, between 6 and 24 months on ART, hemoglobin levels showed a sustained overall increase, the magnitude of which was similar regardless of baseline CD4 level. This increase in hemoglobin was seen even among patients on zidovudine containing regimens. Since low hemoglobin is an established adverse prognostic marker, prompt identification of anemia may result in improved morbidity and mortality of patients initiating ART
Audience Academic
Author Ian Sanne
Simbarashe Takuva
Alana T. Brennan
A. Patrick MacPhail
Mhairi Maskew
Mathew P. Fox
AuthorAffiliation 3 Center for Global Health and Development, Boston University, Boston, MA 02118, USA
1 Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2041, South Africa
4 Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
2 Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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– name: 4 Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Cites_doi 10.1111/j.1365-2141.1992.tb06475.x
10.7326/0003-4819-113-12-926
10.2310/6650.2001.33967
10.1086/521150
10.1186/1471-2334-11-190
10.1097/00042560-199809010-00004
10.1046/j.1537-2995.1986.26587020112.x
10.1097/00002030-199905280-00010
10.1046/j.1537-2995.1990.30290162898.x
10.1089/aid.2007.0219
10.1097/QAD.0b013e3282f2306e
10.1182/blood.V91.1.301
10.1186/1758-2652-13-42
10.1086/338151
10.1186/1758-2652-15-5
10.4172/jaa.1000040
10.1177/135965350601100612
10.1093/ije/dys029
10.1097/00042560-200201010-00007
10.1016/S0149-2918(04)90009-4
10.1097/00002030-200404090-00006
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Copyright Copyright © 2013 Simbarashe Takuva et al.
COPYRIGHT 2013 John Wiley & Sons, Inc.
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References (15) 2010; 13
(22) 2004; 14
(2) 2002; 29
(8) 2011; 11, article 190
(21) 2002; 34
Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0 2004 National Institutes of Health Division of AIDS
(25) 2007; 45
(17) 2013; 42
(3) 1999; 13
(9) 1992; 82
(20) 2008; 22
(27) 2004; 18
(13) 1991; 4
(10) 2004; 26
(12) 1990; 113
National Department of Health, Republic of South Africa National Antiretroviral Treatment Guidelines 2004 Jacana
(23) 2012; 15
(5) 1998; 19
(16) 2006; 11
(26) 2008; 24
(1) 1998; 91
(14) 1986; 26
(11) 1990; 30
(24) 2012; 4
(4) 2002; 185
World Health Organization Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia 2008 Geneva, Switzerland WHO
(7) 2001; 49
9732065 - J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Sep 1;19(1):29-33
15060436 - AIDS. 2004 Apr 9;18(6):887-95
17879931 - Clin Infect Dis. 2007 Oct 15;45(8):1093-101
18090393 - AIDS. 2008 Jan 2;22(1):67-74
2173460 - Ann Intern Med. 1990 Dec 15;113(12):926-33
1486042 - Br J Haematol. 1992 Nov;82(3):608-14
11352180 - J Investig Med. 2001 May;49(3):225-39
21047391 - J Int AIDS Soc. 2010 Nov 03;13:42
15243966 - AIDS Read. 2004 Jun;14(6):305-10, 313-5
14996521 - Clin Ther. 2004 Jan;26(1):92-7
10371175 - AIDS. 1999 May 28;13(8):943-50
2305441 - Transfusion. 1990 Feb;30(2):133-7
11740716 - Clin Infect Dis. 2002 Jan 15;34(2):260-6
2051306 - J Acquir Immune Defic Syndr. 1991;4(7):659-66
3765030 - Transfusion. 1986 Sep-Oct;26(5):405-9
18327976 - AIDS Res Hum Retroviruses. 2008 Mar;24(3):393-9
22434860 - Int J Epidemiol. 2013 Apr;42(2):430-9
9414298 - Blood. 1998 Jan 1;91(1):301-8
21745396 - BMC Infect Dis. 2011 Jul 11;11:190
22289654 - J Int AIDS Soc. 2012 Jan 30;15(1):5
17310818 - Antivir Ther. 2006;11(6):741-9
11807691 - J Infect Dis. 2002 Jan 15;185(2):178-87
11782590 - J Acquir Immune Defic Syndr. 2002 Jan 1;29(1):54-7
22
23
25
26
27
28
(21) 2004
(20) 2004
(24) 2004; 14
10
16
17
19
3
8
(6) 2008
(18) 2006; 11
References_xml – volume: 29
  start-page: 54
  issue: 1
  year: 2002
  end-page: 57
  ident: 2
  article-title: Anemia in HIV-infected patients receiving highly active antiretroviral therapy
  publication-title:
– volume: 34
  start-page: 260
  issue: 2
  year: 2002
  end-page: 266
  ident: 21
  article-title: Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and -uninfected women
  publication-title:
– volume: 45
  start-page: 1093
  issue: 8
  year: 2007
  end-page: 1101
  ident: 25
  article-title: Adverse effects of highly active antiretroviral therapy in developing countries
  publication-title:
– volume: 14
  start-page: 305
  issue: 6
  year: 2004
  end-page: 310
  ident: 22
  article-title: Anemia prevalence and associated risk factors in a single-center ambulatory HIV clinical cohort
  publication-title:
– volume: 18
  start-page: 887
  issue: 6
  year: 2004
  end-page: 895
  ident: 27
  article-title: Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa
  publication-title:
– volume: 30
  start-page: 133
  issue: 2
  year: 1990
  end-page: 137
  ident: 11
  article-title: Red cell transfusion therapy for anemia in patients with AIDS and ARC: incidence, associated factors, and outcome
  publication-title:
– volume: 24
  start-page: 393
  year: 2008
  end-page: 399
  ident: 26
  article-title: Tolerability and effectiveness of first-line regimens combining nevirapine and lamivudine plus zidovudine or stavudine in Cameroon
  publication-title:
– volume: 91
  start-page: 301
  issue: 1
  year: 1998
  end-page: 308
  ident: 1
  article-title: Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project
  publication-title:
– volume: 49
  start-page: 225
  issue: 3
  year: 2001
  end-page: 239
  ident: 7
  article-title: Pathogenesis of anemia during human immunodeficiency virus infection
  publication-title:
– volume: 4
  start-page: 14
  issue: 1
  year: 2012
  end-page: 20
  ident: 24
  article-title: Durability of first line antiretroviral therapy: reasons and predictive factors for modifications in a Swaziland Cohort
  publication-title:
– volume: 4
  start-page: 659
  issue: 7
  year: 1991
  end-page: 666
  ident: 13
  article-title: The usefulness of diagnostic bone marrow examination in patients with human immunodeficiency virus (HIV) infection
  publication-title:
– volume: 19
  start-page: 29
  issue: 1
  year: 1998
  end-page: 33
  ident: 5
  article-title: Anemia and survival in HIV infection
  publication-title:
– volume: 42
  start-page: 430
  issue: 2
  year: 2013
  end-page: 439
  ident: 17
  article-title: Cohort Profile: The Themba Lethu Clinical Cohort, Johannesburg, South Africa
  publication-title:
– volume: 26
  start-page: 92
  issue: 1
  year: 2004
  end-page: 97
  ident: 10
  article-title: Changes in hematologic parameters and efficacy of thymidine analogue based, highly active antiretroviral therapy: a meta-analysis of six prospective, randomized, comparative studies
  publication-title:
– volume: 82
  start-page: 608
  issue: 3
  year: 1992
  end-page: 614
  ident: 9
  article-title: Serum erythropoietin levels in anaemic patients with advanced human immunodeficiency virus infection
  publication-title:
– volume: 113
  start-page: 926
  issue: 12
  year: 1990
  end-page: 933
  ident: 12
  article-title: Persistent B19 parvovirus infection in patients infected with human immunodeficiency virus type 1 (HIV-1): a treatable cause of anemia in AIDS
  publication-title:
– volume: 13
  issue: 1, article 42
  year: 2010
  ident: 15
  article-title: Baseline severe anaemia should not preclude use of zidovudine in antiretroviral-eligible patients in resource-limited settings
  publication-title:
– volume: 11
  start-page: 741
  issue: 6
  year: 2006
  end-page: 749
  ident: 16
  article-title: Prevalence, incidence and predictors of severe anaemia with zidovudine-containing regimens in African adults with HIV infection within the DART trial
  publication-title:
– volume: 13
  start-page: 943
  issue: 8
  year: 1999
  end-page: 950
  ident: 3
  article-title: Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe
  publication-title:
– volume: 22
  start-page: 67
  issue: 1
  year: 2008
  end-page: 74
  ident: 20
  article-title: Antiretroviral therapy using zidovudine, lamivudine, and efavirenz in South Africa: tolerability and clinical events
  publication-title:
– volume: 11, article 190
  year: 2011
  ident: 8
  article-title: Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania
  publication-title:
– volume: 26
  start-page: 405
  issue: 5
  year: 1986
  end-page: 409
  ident: 14
  article-title: Red cell autoantibodies in patients with acquired immune deficiency syndrome
  publication-title:
– volume: 15
  issue: 1, article 5
  year: 2012
  ident: 23
  article-title: Short-term risk of anaemia following initiation of combination antiretroviral treatment in HIV-infected patients in countries in sub-Saharan Africa, Asia-Pacific, and central and South America
  publication-title:
– volume: 185
  start-page: 178
  issue: 1
  year: 2002
  end-page: 187
  ident: 4
  article-title: A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA Study
  publication-title:
– volume: 82
  start-page: 608
  issue: 3
  year: 1992
  ident: 9
  publication-title: British Journal of Haematology
  doi: 10.1111/j.1365-2141.1992.tb06475.x
– volume: 113
  start-page: 926
  issue: 12
  year: 1990
  ident: 12
  publication-title: Annals of Internal Medicine
  doi: 10.7326/0003-4819-113-12-926
– volume: 49
  start-page: 225
  issue: 3
  year: 2001
  ident: 7
  publication-title: Journal of Investigative Medicine
  doi: 10.2310/6650.2001.33967
– ident: 27
  doi: 10.1086/521150
– year: 2004
  ident: 20
– ident: 8
  doi: 10.1186/1471-2334-11-190
– volume: 19
  start-page: 29
  issue: 1
  year: 1998
  ident: 5
  publication-title: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
  doi: 10.1097/00042560-199809010-00004
– volume: 26
  start-page: 405
  issue: 5
  year: 1986
  ident: 14
  publication-title: Transfusion
  doi: 10.1046/j.1537-2995.1986.26587020112.x
– ident: 3
  doi: 10.1097/00002030-199905280-00010
– year: 2008
  ident: 6
– volume: 30
  start-page: 133
  issue: 2
  year: 1990
  ident: 11
  publication-title: Transfusion
  doi: 10.1046/j.1537-2995.1990.30290162898.x
– volume: 4
  start-page: 659
  issue: 7
  year: 1991
  ident: 13
  publication-title: Journal of Acquired Immune Deficiency Syndromes
– ident: 28
  doi: 10.1089/aid.2007.0219
– ident: 22
  doi: 10.1097/QAD.0b013e3282f2306e
– volume: 91
  start-page: 301
  issue: 1
  year: 1998
  ident: 1
  publication-title: Blood
  doi: 10.1182/blood.V91.1.301
– ident: 17
  doi: 10.1186/1758-2652-13-42
– ident: 23
  doi: 10.1086/338151
– volume: 14
  start-page: 305
  issue: 6
  year: 2004
  ident: 24
  publication-title: AIDS Reader
– ident: 25
  doi: 10.1186/1758-2652-15-5
– ident: 26
  doi: 10.4172/jaa.1000040
– volume: 11
  start-page: 741
  issue: 6
  year: 2006
  ident: 18
  publication-title: Antiviral Therapy
  doi: 10.1177/135965350601100612
– ident: 19
  doi: 10.1093/ije/dys029
– volume: 29
  start-page: 54
  issue: 1
  year: 2002
  ident: 2
  publication-title: Journal of Acquired Immune Deficiency Syndromes
  doi: 10.1097/00042560-200201010-00007
– volume: 185
  start-page: 178
  issue: 1
  year: 2002
  ident: 4
  publication-title: Journal of Infectious Diseases
– ident: 10
  doi: 10.1016/S0149-2918(04)90009-4
– year: 2004
  ident: 21
– ident: 16
  doi: 10.1097/00002030-200404090-00006
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Snippet Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of...
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StartPage 23
SubjectTerms Care and treatment
Clinical Study
Development and progression
Health aspects
Highly active antiretroviral therapy
HIV infection
HIV patients
Mortality
Risk factors
South Africa
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Title Anemia among HIV-Infected Patients Initiating Antiretroviral Therapy in South Africa: Improvement in Hemoglobin regardless of Degree of Immunosuppression and the Initiating ART Regimen
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Volume 2013
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