Prevalence and factors associated with moderate-to-severe anaemia among virally suppressed people with HIV at a tertiary hospital in Zambia

• Published in: PloS one Vol. 19; no. 8; p. e0303734
• Main Authors: Kamvuma, Kingsley, Masenga, Sepiso, Hamooya, Benson, Chanda, Warren, Munsaka, Sody
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.08.2024; Public Library of Science (PLoS)
• Subjects: Adult; Anemia; Anemia - complications; Anemia - epidemiology; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Blood pressure; Care and treatment; CD4 antigen; Cell number; Consent; Cross-Sectional Studies; Data collection; Development and progression; Disease control; Disease susceptibility; Distribution; Drug therapy; Efavirenz; Ethylenediaminetetraacetic acid; Evaluation; Exercise; Female; Health aspects; Health risks; Health services; Hemoglobin; Hepatitis; HIV; HIV (Viruses); HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospitals; Human immunodeficiency virus; Humans; Infections; Laboratories; Lymphocytes; Male; Medicine and Health Sciences; Middle Aged; Observational studies; Patient outcomes; Population; Prevalence; Prevalence studies (Epidemiology); Public health; Questionnaires; Regression analysis; Risk assessment; Risk Factors; Sample size; Sociodemographics; Statistical analysis; Teaching hospitals; Tertiary Care Centers; Tuberculosis; Womens health; Zambia - epidemiology; Zambia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0303734

Anaemia is associated with an increased risk of disease progression and all-cause mortality among HIV-infected individuals, regardless of the type of anaemia, but the magnitude of the risk is greater with more severe forms of anaemia. Although anaemia PLWH has been extensively studied, the focus has primarily been on its prevalence and association with disease progression in untreated or poorly controlled HIV cases. This study aimed to investigate the prevalence, and factors associated with moderate-to-severe anaemia among virally suppressed HIV patients at a tertiary hospital in Zambia. We conducted a cross-sectional study of ART-treated PLWH for at least 6 months at Livingstone University Teaching Hospital (LUTH). Sociodemographic, clinical, and laboratory were the data collected. The primary outcome moderate to severe anaemia was defined as follows; moderate anemia as haemaoglobin levels between 8.0-10.9 g/ and severe anemia as haemoglobin levels less than 8.0 g/dL according to the WHO classification. Logistic regression was performed to identify factors associated with moderate-to-severe anaemia. Among 823 participants with viral suppression, the overall prevalence of anaemia and moderate-to-severe anaemia was 29.4% (n = 242; 95% confidence interval (CI): 26.3-32.6) and 14.2% (n = 117, 95% CI: 11.7-18), respectively. In the adjusted logistic regression analysis, women had higher odds of moderate to severe anaemia compared to men (AOR 2.618, 95% CI 1.182-5.799). Lymphocyte count (AOR 0.525, 95% CI 0.31-0.90) and higher BMI (AOR 1.0671, 95% CI 1.01-1.13) were also significant factors. Microcytosis (AOR 49.79, 95% CI 12.95-191.49) and normocytosis (AOR 4.38, 95% CI 1.22-15.75) were strongly associated with higher odds compared to macrocytosis. NNRTI treatment was associated with higher odds of anaemia compared to INSTI treatment (AOR 5.231, 95% CI 1.04-26.33). Traditional risk factors for anaemia like CD4+ count and tuberculosis infection were not significant. We found a higher prevalence of anaemia and moderate-to-severe anaemia in virally suppressed PLWH, suggesting factors beyond HIV contribute to the persistence of anaemia in this cohort. Women, lower lymphocyte count, higher BMI, low mean corpuscular volume (microcytosis) indicative of microcytic anaemia, and NNRTI-based ART regimens were independently associated with moderate-to-severe anaemia. Further research is warranted to explain the underlying mechanisms and optimize clinical management to improve outcomes among virally suppressed PLWH.