Anemia and Decline of CD4 Cell Count in HIV+ Drug Users in Miami

Abstract

Objective:This study investigates the association of anemia with HIV disease progression and survival over 30 months in HIV+ drug users in Miami.Methods:After obtaining consent, demographic and medical questionnaires were completed every 6 months for 30 months in HIV+ drug users. Blood was drawn for CD4 cell count, viral load, and CBC. Anemia was defined as hemoglobin <12g/dL in women and <14g/dL in men, and hematocrit<37% in women and <42% in men. Kaplan Meier Estimation was used to evaluate the rate of decline of CD4 cell count and mortality over 30 months.Results:Of 231 participants, 77% were black, and 73% were men. Mean age was 42 years ± 7.1. The prevalence of anemia was 46% (n=106). Of those with anemia, only 19% had macrocytic/normochromic anemia and 0.05% microcytic/hypochromic anemia, suggesting nutritional deficiency. Anemia was significantly associated with a more rapid decline of CD4 cell count to below 200 cells/μL (p<0.001) when compared to participants without anemia. There was also a trend in decreased survival overtime in those who had anemia compared to those without anemia, (80% vs. 94%, p=0.094).Conclusions:Nutritional etiologies of anemia do not seem to be the predominant cause of anemia in this cohort. Anemia in our cohort was strongly related to advanced HIV disease and efforts to identify the cause and provide treatment may help to delay disease progression.Funded by NIDA