Abstract
BackgroundAnemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking.MethodsWithin a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010–3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between time-updated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site.ResultsThis retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3–7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR.ConclusionBecause anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.
Highlights
Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes
While estimates of anemia prevalence vary depending on factors including age, setting, HIV disease stage, use of antiretroviral therapy (ART), sex, and injection drug use status [2, 3], it is estimated that 18–32% of PLWH without AIDS and 48–85% of PLWH with clinical AIDS have anemia in the United States, compared to 15–17% of people living without HIV [3, 5]
Participants had a median of 14 hemoglobin values measured during a median follow-up of 6.6 years
Summary
Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Anemia (hemoglobin < 10 g/dL) and severe anemia (hemoglobin< 7.5 g/dL) [1] are common among people living with HIV (PLWH) [2], and the prevalence of anemia increases with HIV disease severity [3, 4]. While estimates of anemia prevalence vary depending on factors including age, setting, HIV disease stage, use of antiretroviral therapy (ART), sex, and injection drug use status [2, 3], it is estimated that 18–32% of PLWH without AIDS and 48–85% of PLWH with clinical AIDS have anemia in the United States, compared to 15–17% of people living without HIV [3, 5]. Additional mechanisms for HIV-related anemia include deficiencies of vitamin B12, folate, or iron [13]
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