Abstract
Objective: Macrocytic anemia (MA) is the most common type of anemia in adult HIV-infected patient on azidothymidine (AZT) regimen. The common causes of MA are vitamin B12 and folate deficiency, marked by homocysteinemia. AZT consumption causes homocysteinemia is still controversial. This study aimed to determine the role of AZT consumption and homocysteinemia in developing MA.
 Materials and Methods: This was a case-control study involving adult HIV-infected patient who administered AZT in 12 health care facilities in Central Java Province, Indonesia. Sociodemographic data were obtained through interviews and medical records, while laboratory data included hemoglobin level and mean corpuscular volume (MCV) were measured using the automatic hematology analyzer. Homocysteine level was measured using immunoassay. WHO references was used to diagnose anemia. Macrocytic was determined when MCV >96 fl. The cut-off homocysteinemia was >10 μmol/L. Length of AZT consumption was classified into ≤6 months and >6 months. Data were analyzed using multivariate logistic regression test.
 Results: The population of this study was 503 adult HIVinfected on AZT regimen. In total, there were 116 subjects (age mean±SD: 41,9±9,4) who had MA and 116 controls (age mean±SD: 36,2±8,3) without anemia. Prevalence of anemia was 29.4% and the majority (78.4%) had MA. The odds of having MA among adult HIV infected patient on AZT regimen > 6 months was 0.25 times compared to patients who were on AZT regimen ≤6 months (95% CI 0.08-0.72, p=0.011), homocysteinemia was protective factor of MA (OR 0.43,95% CI 0.24-0.79, p=0.006).
 Conclusion: The length of AZT consumption >6 months and homocysteinemia are protective factors of MA among adult HIV-infected patient.
 Bangladesh Journal of Medical Science Vol.19(4) 2020 p.638-645
Highlights
Human Immunodeficiency Virus (HIV) infection has emerged as one of worldwide health problems
The sample used in the previous study was smaller (54 people) compared to this study.7Generally, the most common cause of macrocytic anemia is vitamin B12 and folate deficiency.19–21Gastrointestinal complications were often found in HIV patients, such as an increase in inflammation and slow mucosa repair due to virus replication, which results in lamina propia thinning and cause vitamin B12 and folate malabsorption.7In New York, 13% of macrocytic anemia case was related to AZT treatment.36AZT is a thymidine analogue with the biggest effect towards MCVand is related to macrocytic anemia.[37]
We found a significant difference between the occurrence of macrocytic anemia in patients treated with AZT for >6 months and ≤6 months (p=0,011)
Summary
Human Immunodeficiency Virus (HIV) infection has emerged as one of worldwide health problems. Inclusion criteria in this study were adult HIV patients aged 20 to 5928 who received AZT treatment for ≥4 weeks and was not pregnant during the conduction of this study. Inclusion criteria of control group were subjects who did not have anaemia (normal Hb levels). Subjects were later HIV positive who have received AZT ≥ 4 weeks, categorized into macrocytic anaemia if levels of not pregnant, and signed informed consent. Based on multivariate analysis results (see table 2), female sex, and age group (age 40-49 and 50-59 years old) were found to be risk factors of macrocytic anemia. AZT treatment for >6 months and Hcy levels of >10μmol/L were protective factors towards macrocytic anemia incidence in adult HIV patients who received AZT treatment. 9,06 times higher (95% CI 2,95-27,82; p=
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