Abstract
Objective: Anemia is responsible for poor outcomes in HIV/AIDS patients. It’s related to disease progression, morbidity, and mortality. Antiretroviral therapy (ART) agent, zidovudine (ZDV) is also known to trigger anemia in the early initiation. However, studies found improved hemoglobin (Hb) levels of HIV/AIDS patients several months after ART routinely taken. This study aims to find the impact and correlation of ART on the hemoglobin level of HIV/AIDS patients.
 Methods: A retrospective cohort study was done at Merpati Clinic, Wangaya Hospital, Denpasar-Bali, Indonesia. Data were collected from medical records and laboratory results. A total sample of 64 HIV/AIDS patients with at least 6 mo on ART was included in this study.
 Results: Anemia was found in 34 (53.1%) of patients before ART initiation. After taking ART for 6 mo, we observed a significant improvement in patients’ hemoglobin levels, 48 (75%) shows increased hemoglobin levels. The paired t-test revealed a correlation between ART and Hb level (p<0.001). Fourteen (43.8%) patient taking ZDV shows no improvement, even declining of Hb level. Chi-square analysis performed with p = 0.001 to ZDV and lower or no improvement of hemoglobin level. Both results considered statistically significant (p-value less than 0.05) with a confidence interval (CI) of 95%. Relative risk (RR) of no improvement or decline in Hb level is 7 folds higher in the ZDV group than the non-ZDV group.
 Conclusion: This study concludes that ART affects hemoglobin levels in HIV/AIDS patients. Zidovudine regimen is more prone to lower or no increase of Hb.
Highlights
Anemia is considered as a frequently found hematological problem affecting more than one-third of HIV patients [1, 2]
This study concludes that Antiretroviral therapy (ART) affects hemoglobin levels in HIV/AIDS patients
This study aims to find the impact of ART on the hemoglobin level of HIV patients visiting Merpati Clinic, Wangaya Hospital, Denpasar-Bali, Indonesia
Summary
Anemia is considered as a frequently found hematological problem affecting more than one-third of HIV patients [1, 2]. Previous researches have reported that the prevalence of anemia in HIV naïve patients varies between 25.8-34.6% [2,3,4]. Other studies found a higher prevalence of anemia in 71-86.4% of HIV/AIDS patients. Anemia in HIV patients correlates strongly to disease progression, morbidity, and mortality. The decrease of CD4 counts strongly associated with the severity of anemia [8, 9]. Mild anemia is described as a hemoglobin level of 11-11.9 g/dl. Moderate anemia is when the hemoglobin level 8-10.9 g/dl. The diagnosis of severe anemia is made if the hemoglobin level is
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