Abstract
BackgroundAnemia is common among people living with HIV infection and is frequently associated with poor quality of life and poor prognosis. It has been well described in antiretroviral naïve individuals and those on non-nucleoside reverse transcriptase inhibitor-based first line antiretroviral therapy (ART) regimens. However there is limited information on anemia for ART experienced individuals on protease inhibitor-based second line ART regimens in resource limited settings. Our objective was to describe the prevalence and risk factors of anemia in this ART experienced population in Malawi.MethodsWe conducted a cross-sectional study using routine facility data at two HIV clinics in Lilongwe, Malawi. The analysis included individuals receiving protease inhibitor-based second line ART. Clinical and laboratory data were collected at routine clinic visits. We used descriptive statistics, two-sample t-tests and multivariate logistic regression for data analysis.ResultsThree hundred seventy-seven records were included in this analysis (37% male, median age 41 years, median CD4 count 415 cells/μL). The prevalence of anemia was 125/377 (33.2%) − mild, moderate and severe anemia was 17.5%, 13.8%, and 1.9% respectively. Female participants had a higher prevalence than male participants (43.6% vs. 15.7%, p < 0.001). In multivariate logistic regression, female sex (adjusted odds ratio (aOR) 5.3; 95% CI 2.9–9.5) and a CD4 count <200 cell/ul (aOR 3.1; 95%CI 1.6–6.0) were associated with increased risk of having anemia while a BMI ≥30 kg/m2 (aOR 0.8; 95% CI 0.6–1.0) and being on ART for more than 10 years (aOR 0.4; 95% CI 0.2–0.9) were associated with reduced risk of anemia. Being on a zidovudine- containing ART regimen was not associated with anemia.ConclusionAnemia is common in people on second line ART in Lilongwe, Malawi. Screening for anemia in this population would be a useful strategy; especially for female patients, those who are underweight and have a low CD4 cell counts.
Highlights
Anemia is common among people living with Human Immunodeficiency Virus (HIV) infection and is frequently associated with poor quality of life and poor prognosis
Individuals who recover from anemia have better clinical outcomes [7]. reducing anemia is a key component of care in people living with HIV
Three hundred ninety-two individuals on second line antiretroviral therapy (ART) were enrolled in the study. 5 records were excluded from the analysis because the individuals were not on second line ART; they had been erroneously included and their records showed they were not on second line ART during data analysis
Summary
Anemia is common among people living with HIV infection and is frequently associated with poor quality of life and poor prognosis. It has been well described in antiretroviral naïve individuals and those on nonnucleoside reverse transcriptase inhibitor-based first line antiretroviral therapy (ART) regimens. Sub-Saharan Africa has a high prevalence of people living with HIV (PLHIV) with anemia In these individuals anemia is associated with malnutrition, low CD cell counts and comorbidities such as tuberculosis [2, 3]. For PLHIV on second line ART regimens, the prevalence and risk factors of anemia are not well known even though persistent anemia continues to be clinically relevant while taking ART [10, 11]
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