Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania

Asgeir Johannessen,Ezra Naman,Svein G Gundersen,Johan N Bruun

doi:10.1186/1471-2334-11-190

Abstract

BackgroundHIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART) in rural Africa is poorly understood.MethodsHIV-infected adults (≥15 years) who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine) on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. We applied paired sample T-tests to compare hemoglobin levels before and one year after ART initiation, and logistic regression models to identify predictors of persistent anemia.ResultsAt enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4%) were anemic. Of the anemic patients, 254 (39.1%) had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (P < 0.001); however, 39 patients (38.2%) were still anemic after 12 months of ART. Independent predictors of persistent anemia were mean cell volume in the lower quartile (<76.0 fL; Odds Ratio [OR] 4.34; 95% confidence interval [CI] 1.22-15.5) and a zidovudine-containing initial regimen (OR 2.91; 95% CI 1.03-8.19).ConclusionsMost patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.

Highlights

HIV-associated anemia is common and associated with poor prognosis
In a subset of patients who were anemic at the time they started antiretroviral treatment (ART) and had a follow-up hemoglobin measurement 12 months later we studied the effect of ART on HIV-associated anemia
To assess whether the hemoglobin increase could be a result of other factors associated with enrollment in HIV care rather than ART itself, we studied the hemoglobin evolution in 18 non-pregnant adults who were anemic at enrollment and had a follow-up hemoglobin measurement 12 months later, but did not start ART

Summary

Introduction

HIV-associated anemia is common and associated with poor prognosis. its response to antiretroviral treatment (ART) in rural Africa is poorly understood. Anemia is a common feature of HIV infection, occurring in approximately 35% of patients who initiate antiretroviral treatment (ART) in Europe and North America [1]. In addition to causing reduced physical functioning and quality of life, a number of studies have found that anemia at the time of ART initiation is associated with HIV disease progression and mortality [2,3,4,5,6,7,8,9]. It is uncertain whether the association between anemia and mortality is causal or whether anemia acts as a surrogate marker of underlying disease. Several other etiologic factors may be involved in the development of HIV-associated anemia, including micronutrient deficiencies, immunological myelosuppression, impaired erythropoietin production and blood loss from intestinal opportunistic disease

Objectives

Methods

Results

Discussion

Conclusion