Anaemia in a rural Ugandan HIV cohort: prevalence at enrolment, incidence, diagnosis and associated factors

Mugisha, Joseph; Shafer, Leigh Anne; Paal, Lieve Van der; Mayanja, Billy N.; Eotu, Henry; Hughes, Peter J.; Whitworth, Jimmy; Grosskurth, Heiner

doi:10.1111/j.1365-3156.2008.02069.x

Cited by 43 publications

(62 citation statements)

References 17 publications

(25 reference statements)

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“…18 Lower Hb levels in HIV-infected than uninfected individuals are nearly universally observed, and our finding is similar to prior studies from sub-Saharan Africa, for example, HIV-infected women were more likely to be anaemic than HIV negative women (23.6% vs 12.8%; p=0.031) in a Ugandan study. 20 In a recent Rwandan study of 200 HIV-infected (of whom 50 were on ART) and 50 uninfected women, the prevalence of anaemia was similar to our study (29% and 8%, respectively). 23 Poor nutritional status may also cause anaemia, 17 which may be reflected in the association of anaemia with lower BMI in this urban Rwandan population.…”

Section: Discussionsupporting

confidence: 87%

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

et al. 2012

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ObjectivesAlthough haematological abnormalities are common manifestations of HIV infection, few studies on haematological parameters in HIV-infected persons have been undertaken in sub-Saharan Africa. The authors assessed factors associated with haematological parameters in HIV-infected antiretroviral-naïve and HIV-uninfected Rwandan women.Study designCross-sectional analysis of a longitudinal cohort.SettingCommunity-based women's associations.Participants710 HIV-infected (HIV+) antiretroviral-naïve and 226 HIV-uninfected (HIV−) women from the Rwanda Women's Interassociation Study Assessment. Haematological parameters categorised as (abnormal vs normal) were compared by HIV status and among HIV+ women by CD4 count category using proportions. Multivariate logistic regression models using forward selection were fit.ResultsPrevalence of anaemia (haemoglobin (Hb) <12.0 g/dl) was higher in the HIV+ group (20.5% vs 6.3%; p<0.001), and increased with lower CD4 counts: ≥350 (7.6%), 200–349 (16%) and <200 cells/mm3 (32.2%). Marked anaemia (Hb <10.0 g/dl) was found in 4.2% of HIV+ and none of the HIV− women (p<0.001), and was highest in HIV+ women with CD4 <200 cells/mm3 (8.4%). The HIV+ were more likely than HIV− women (4.2 vs 0.5%, respectively, p=0.002) to have moderate neutropenia with white blood cells <2.0×103 cells/mm3 and 8.4% of HIV+ women with CD4 <200 cells/mm3 had moderate neutropenia. In multivariate logistic regression analysis, BMI (OR 0.87/kg/m2, 95% CI 0.82 to 0.93; p<0.001), CD4 200–350 vs HIV− (OR 3.59, 95% CI 1.89 to 6.83; p<0.001) and CD4 <200 cells/mm3 vs HIV− (OR 8.09, 95% CI 4.37 to 14.97; <0.001) had large independent associations with anaemia. There were large independent associations of CD4 <200 cells/mm3 vs HIV− (OR 7.18, 95% CI 0.78 to 65.82; p=0.081) and co-trimoxazole and/or dapsone use (OR 5.69, 95% CI 0.63 to 51.45; p=0.122) with moderate neutropenia.ConclusionsAnaemia was more common than neutropenia or thrombocytopenia in the HIV-infected Rwandan women. Future comparisons of haematological parameters in HIV-infected patients before and after antiretroviral therapy initiation are warranted.

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Section: Discussionsupporting

confidence: 87%

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

et al. 2012

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“…This study showed that 49.5% of the sample population had anaemia, which is higher than the 18.9% prevalence reported in Uganda [13] but lower than 80% obtained by Erhabor et al in Port Harcourt, Nigeria, among untreated HIV patients [14]. This study is in agreement with previous studies by Akinsegun et al [15], Zon and Groopman [7], Spivak et al [16] and a multicentre AIDS cohort study showing that anaemia was directly related to the degree of immunosupression [16].…”

Section: Discussioncontrasting

confidence: 46%

Relation between some haematological abnormalities, degree of immunosuppression and viral load in treatment-naïve HIV-infected patients

Denue¹,

Gashau²,

Bello³

et al. 2013

East Mediterr Health J

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This cross-sectional study at a teaching hospital in north-eastern Nigeria estimated the prevalence of anaemia, leukopenia and thrombocytopenia in treatment-naïve HIV-infected patients (177 males and 316 females), and the associations with virological and immunological markers. The overall prevalences of anaemia, leukopenia and thrombocytopenia were 49.5%, 5.5% and 4.5% respectively. The prevalence of anaemia was significantly higher in males than females (61.6% versus 42.7%), while the rates of leukopenia (5.1% versus 5.7%) and thrombocytopenia (5.7% versus 3.8%) were similar. Almost two-thirds of the HIV treatment-naïve studied patients, 293/493 (59.4%), had cytopenia and would require antiretroviral drugs. AIDS was diagnosed by clinical or immunological criteria in 70% of patients. The degree of cytopenia was directly related to the degree of immunosuppression and clinical AIDS status. No relationship was observed between cytopenia and viral load.

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“…The HIV-infected women were particularly more likely than HIV-negative women to be anemic (23.6% and 12.8%, respectively; P = 0.031). 21 The lower percentage of anemia among HIV-negative women in our study may be related to the fact that the women coming to outpatient department of Butare University Teaching Hospital come from the urban area and have a better nutritional status than the general population.…”

Section: Discussionmentioning

confidence: 79%

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Masaisa¹,

Gahutu²,

Mukiibi³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. To determine the prevalence and risk factors of anemia among human immunodeficiency virus (HIV)-infected women in Rwanda and the influence of highly active antiretroviral therapy (HAART) on anemia, we analyzed 200 HIV-positive women and 50 HIV-negative women in a cross-sectional study. Clinical examinations and iron and vitamin B 12 assays were performed, and complete blood counts, serum folic acid levels, and CD4 cell count determined. The prevalence of anemia was significantly higher among HIV-positive women (29%) than among HIV-negative women (8%) ( P < 0.001). Risk factors for anemia were lower body mass index (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 2.4-4.1), zidovudine use (OR = 1.14, 95% CI = 1.01-1.29), lack of HAART (OR = 1.44, 95% CI = 1.21-1.67), oral candidiasis (OR = 1.4, 95% CI = 1.2-1.6), pulmonary tuberculosis (OR = 1.8, 95% CI = 1.7-2.2), cryptococcal meningitis (OR = 1.6, 95% CI = 1.21-1.8), Pneumocystis jiroveci pneumonia (OR = 1.41, 95% CI = 1.20-1.65) and CD4 lymphocyte count < 200 cells/µL (OR = 2.41, 95% CI = 2.01-3.07). The mean ± SD hemoglobin level of 10.9 ± 1.6 g/dL at HAART initiation significantly increased to 12.3 ± 1.5 g/dL in 8 months ( P < 0.001). Anemia increases with HIV stage, and HAART is associated with a significant improvement in hemoglobin levels.*Address correspondence to Jean Bosco Gahutu, Faculty of Medicine, National University of Rwanda, PO Box 30, Huye, Rwanda. E-mail: jgahutu@nur.ac.rw 457 ANEMIA IN HIV-INFECTED AND UNINFECTED WOMEN, RWANDA level < 11.5 mg/dL by using reference ranges based upon local control measurements in our laboratory, which is located at a moderate altitude of 1,768 meters. This limit was also shown by Beutler and Waalen. 20 Serum iron, vitamin B 12 , and folic acid levels were measured in the clinical laboratory of Ghent University Hospital. However, erythropoietin assays and the screening for malaria and chronic helminthes were not systematically conducted.The first-line HAART regimen at the time of the study consisted of stavudine or zidovudine, plus lamivudine, plus nevirapine or efavirenz; more patients used stavudine and nevirapine than zidovudine and efavirenz. For all the patients who initiated HAART at the time of entry into the study, they were all given a stavudine-based regimen. No patients were taking other antiretroviral medications such as tenofovir, abacavir, or protease inhibitors. Women receiving zidovudine for prevention of mother-to-child transmission of HIV were not included in the study population.Most patients were given cotrimoxazole prophylaxis with a dose of 1 tablet of 960 mg daily when CD4 cell counts were less than 350 cells/μL when possible. However, because many patients initially only sought care when they have reached advanced stages of immunosuppression, some patients were given prophylaxis at lower CD4 cell counts. No persons were offered ferrous sulfate and/or multivitamins for the treatment of anemia.Statistical analysis. All statistical analyses were performed with SPSS software ...

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Anaemia in a rural Ugandan HIV cohort: prevalence at enrolment, incidence, diagnosis and associated factors

Cited by 43 publications

References 17 publications

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study

Relation between some haematological abnormalities, degree of immunosuppression and viral load in treatment-naïve HIV-infected patients

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

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