Abstract
BackgroundStavudine is no longer recommended as part of first-line therapy for patients initiating antiretroviral therapy (ART) in Uganda. Most patients are currently initiated on zidovudine-containing regimens, which can induce anaemia. We investigated the risk factors for early severe anaemia in the first six months of ART initiation.MethodsWe defined baseline (ART initiation) anaemia as haemoglobin (Hb) ≤9.5 g/dL, baseline severe anaemia as Hb ≤8 g/dL, and early severe anaemia as Hb ≤8 g/dL within six months of ART initiation. Risk factors for the development of early severe anaemia were analyzed using a multivariable logistic regression model.ResultsIn total, 5494 patients initiated ART, 821 (15%) had baseline anaemia, and 296 (5%) had baseline severe anaemia. Early severe anaemia occurred in 109 (4%) of 3105 patients who had at least one Hb measurement in the first six months on ART. Patients with baseline anaemia had a larger increase in Hb (median g/dL [IQR]) within the first six months compared with non-anaemic patients (2.9 [1.7, 4.6] vs. 0.7 [-0.2, 1.7], p < 0.0001). Having a new tuberculosis episode OR 3.69 (95% CI 1.64 - 8.32), MCV <80fL OR 1.60 (95% CI 1.01- 2.52) and baseline severe anaemia OR 5.27 (95% CI 3.00 - 9.26) were associated with early severe anaemia. Initiation on a zidovudine-based regimen was not associated with an increased risk of early severe anaemia.ConclusionsAmong patients in an urban HIV clinic in Uganda, severe anaemia is modestly prevalent at ART initiation and improves with ART in the majority of patients. These data suggest that baseline severe anaemia should not be used as a criterion for avoiding the use of zidovudine in patients initiating ART in resource-limited settings.
Highlights
Stavudine is no longer recommended as part of first-line therapy for patients initiating antiretroviral therapy (ART) in Uganda
Baseline characteristics We studied the data recorded for 5494 patients from our clinic who had baseline Hb measurements and were initiated on an AZT- or d4T-containing ART regimen between January 2004 and January 2009 (See additional file 1: description of patients at the Infectious Diseases Institute)
Patients with baseline anaemia had a larger increase in Hb within the first six months compared with those who were non-anaemic
Summary
Stavudine is no longer recommended as part of first-line therapy for patients initiating antiretroviral therapy (ART) in Uganda. Most patients are currently initiated on zidovudine-containing regimens, which can induce anaemia. Before the introduction of antiretroviral therapy (ART), the prevalence of anaemia (defined as a haemoglobin level of less than 10 g/dL) ranges from 15% in asymptomatic patients to 50% in patients with a diagnosis of AIDS [1]. Since 2008, stavudine (d4T) is no longer recommended as part of first-line therapy for patients initiating ART in Uganda due to short- and long-term toxicity [13]. Due to the high cost and short supply of TDF, there is still significant continuing d4T use, and the majority of ART-eligible patients in Uganda are initiated on AZT-containing regimens [14]
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