Anemia in a cohort of HIV-infected Hispanics: prevalence, associated factors and impact on one-year mortality

Abstract

BackgroundAnemia occurs frequently in HIV-infected patients and has been associated with an increased risk of death in this population. For Hispanic subjects, information describing this blood disorder during HIV is scarce. Therefore, the present study examined data from a cohort of HIV-positive Hispanics to determine the prevalence of anemia, identify its associated factors, and evaluate its relationship with one-year mortality.MethodsThis study included 1,486 patients who enrolled between January, 2000 and December, 2010 in an HIV-cohort in Bayamón, Puerto Rico. Data were collected through personal interviews and medical record abstractions. To determine the factors independently associated with anemia, a multivariable logistic regression model was used. Kaplan-Meier and Cox proportional hazards models were also performed to estimate survival time and to predict death risk.ResultsThe prevalence of anemia at enrollment was 41.5%. Factors independently associated with increased odds of anemia were: unemployment (OR = 2.02; 95% CI 1.45-2.79), CD4 count <200 cells/μL (OR = 2.66; 95% CI 1.94-3.66), HIV viral load ≥100,000 copies/mL (OR = 1.94; 95% CI 1.36-2.78), white blood cell count <4,000 cells/μL (OR = 2.42; 95% CI 1.78-3.28) and having clinical AIDS (OR = 2.39; 95% CI 1.39-4.09). Overweight (OR = 0.43; 95% CI 0.32-0.59) and obese (OR = 0.44; 95% CI 0.29-0.67) BMI’s were independently associated with reduced odds of anemia. Survival differed significantly by anemia status (log-rank test: p < 0.001). One-year mortality estimates were: 30.8%, 23.3%, 8.4% and 2.5%, for patients with severe, moderate, mild and no anemia, respectively. Having anemia at baseline was independently associated with an increased one-year mortality risk (severe anemia: HR = 9.06; 95% CI: 4.16-19.72; moderate anemia: HR = 6.51; 95% CI: 3.25-13.06; mild anemia: HR = 2.53; 95% CI: 1.35-4.74).ConclusionsA high prevalence of anemia at enrollment was observed in this cohort of HIV-infected Hispanics. Unemployment and several adverse prognostic features of HIV infection were independently associated with this blood disorder. Anemia resulted to be the strongest predictor of one-year mortality, evidencing a dose–response effect. Further investigations are needed to evaluate whether recovering from anemia is associated with longer survival, and to identify the types of anemia affecting this particular group of HIV patients.

Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality

“…Anaemia is an independent predictor of mortality and disease progression in HIV-infected patients and mortality increases with decreasing haemoglobin concentration (6, 32). Previous studies reported an estimated one-year mortality of 3.7% in HIV-infected patients without anaemia and up to 30-55% in severe anaemia in resource limited settings (5, 6). Our study results are consistent with these outcomes.…”

“…In sub-Saharan Africa, 60% of HIV-infected adults are anaemic and 22% are severely anaemic (3, 4). Anaemia is independently associated with an increased one-year mortality in HIV infection of 8%, which rises to 55% in those with severe anaemia (5, 6).…”

Anemia in combined antiretroviral treatment-naive HIV-infected patients in China: A retrospective study of prevalence, risk factors, and mortality

“…Similarly, Santiago-Rodríguez et al (17) reported that anemia was the strongest predictor of mortality in a cohort of HIV-infected Hispanics, and that the risk of mortality was proportional to the severity of anemia. In a study involving a large urban HIV clinical practice in the US, Moore et al (32) indicated that the development of anemia was associated with decreased survival, independent of other prognostic factors.…”

“…Both clinically advanced disease and low CD4 counts are associated with an increased risk of anemia (17). In China, the prevalence of anemia varies markedly between different regions (3), and mild anemia is prone to be neglected in clinical work.…”

Acute Kidney Injury in HIV-Infected Versus Non-Infected Persons: What Difference?

“…This significant proportion of anemia could be due to the inflammatory syndrome associated with the infection causing AKI, on the one hand, and to HIV infection, on the other hand. Factors associated with anemia in this group were female gender, low CD4 count (<200 cells/mm 3 ) and high viral load [12,13].…”