Short‐term risk of anaemia following initiation of combination antiretroviral treatment in HIV‐infected patients in countries in sub‐Saharan Africa, Asia‐Pacific, and central and South America

Jialun Zhou,Kara Wools‐Kaloustian,Beverly Musick,Antoine Jaquet,Emmanuel Bissagnene,Nicola Maxwell,Matthew Law,Andrew Boulle,Daniel Masys,Jeniffer Iriondo‐Perez,Jay Hemingway‐Foday,Firas Wehbe

doi:10.1186/1758-2652-15-5

Abstract

BackgroundThe objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy (cART) in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration.MethodsAnaemia was defined as haemoglobin of < 10 g/dL. Patients were included if they started cART with three or more drugs, had prior haemoglobin of > = 10 g/dL, and had one or more follow-up haemoglobin tests. Factors associated with anaemia up to 12 months were examined using Cox proportional hazards models and stratified by IeDEA region.ResultsBetween 1998 and 2008, 19,947 patients initiated cART with baseline and follow-up haemoglobin tests (7358, 7289, 2853, 471, 1550 and 426 in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions, respectively). At initiation, anaemia was found in 45% of Western Africa patients, 29% of Eastern Africa patients, 21% of Southern Africa patients, 36% of Central Africa patients, 15% of patients in Asian-Pacific and 14% of patients in Caribbean and Central and South America. Among patients with haemoglobin of > = 10 g/dL at baseline (13,445), the risks of anaemia were 18.2, 6.6, 9.7, 22.9, 11.8 and 19.5 per 100 person-years in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian, and Caribbean and Central and South America regions, respectively. Factors associated with anaemia were female sex, low baseline haemoglobin level, low baseline CD4 count, more advanced disease stage, and initial cART containing zidovudine.ConclusionsIn data from 34 cohorts of HIV-infected patients from sub-Saharan Africa, Central and South America, and Asia, the risk of anaemia within 12 months of initiating cART was moderate. Routine haemoglobin monitoring was recommended in patients at risk of developing anaemia following cART initiation.

Highlights

The objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration
The number of cohorts contributing patients varied between IeDEA regions: 12 in Western Africa (WA), one in EA, seven in Southern Africa (SA), 10 in Central Africa (CA), one in TA, and three in Central and South America (CSA)
There were more female patients in WA, EA, SA and CA compared with TA and CSA, which had a majority of male patients

Summary

Introduction

The objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy (cART) in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration. According to World Health Organization (WHO) estimations [1], access to combination antiretroviral treatment (cART) has improved dramatically in low- and middle-income countries with limited resources. At the end of 2009, almost 5.3 million people were receiving antiretroviral therapy in low- and middle-income countries, an increase of more than 1.2 million people from December 2008. With the newly updated treatment guidelines, the number of people estimated to be in need of cART increased from 10 million to close to 15 million at the end of 2009. The 2010 WHO guidelines recommend that countries using d4T in their first-line regimens phase d4T out and replace it with either AZT or tenofovir in order to prevent long-term toxicity [2]

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