Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Petraro, Paul; Duggan, Christopher; Spiegelman, Donna; Hertzmark, Ellen; Makubi, Abel; Chalamilla, Guerino; Siril, Helen; Sando, David; Aboud, Said; Fawzi, Wafaie W.

doi:10.4269/ajtmh.15-0587

Cited by 18 publications

(19 citation statements)

References 25 publications

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“…In more recent years, AZT use has decreased substantially as other, better-tolerated ART medications have become available. Though prior research has found that being on ART is associated with lower anemia incidence and severity for most PLWH [23,[33][34][35] due to the ability of ART to control HIV disease progression, we did not find an association between ART use and a reduction in anemia or severe anemia incidence in the present study. This may be explained by possible pro-anemic side effects of certain types of currently used ART regimens [36].…”

Section: Discussioncontrasting

confidence: 96%

“…Lower CD4 cell count has been previously identified as a risk factor for anemia. The present study confirmed these findings, however we report much larger increased risks of anemia (HR = 8.40, 95%CI: 6.85, 10.51) and severe anemia (HR = 15.53, 95%CI:11.56-20.92) among PLWH with CD4 cell counts < 100 cells/mm 3 than have been previously reported [20][21][22][23][24]. Risks this large in magnitude suggest that additional screening and careful monitoring would potentially be useful among participants with CD4 levels < 100 cells/mm 3 .…”

Section: Discussionsupporting

confidence: 91%

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Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

et al. 2020

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Background: Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking. Methods: Within a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010-3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between timeupdated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site.Results: This retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3-7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR. Conclusion: Because anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionsupporting

confidence: 91%

Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

et al. 2020

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“…However, the prevalence of anemia in HIV-positive patients was lower in this study than in studies conducted in other areas of Ethiopia including Debre Tabor (34%) [15], Arba Minch (53.6%) [18], Gondar (35%) [7], and Zewditu Memorial Hospital (42.9%) [14]. Similarly, our results were much lower than those found in studies of patients from Nigeria (60.61%) [22], Tanzania (56%) [23], Bayamón, Puerto Rico (41%) [24], Nepal (55.8%) [25], and China (39.2%) [26]. However, the overall prevalence of anemia among HIV-positive adults was higher than that found in patients from Jimma (23.1%) [8], India (16.2%) [9], and Ghana (23.8%) [27].…”

Section: Discussioncontrasting

confidence: 86%

“…Adults taking an anti-TB treatment at the time of ART initiation were 80% less likely to have anemia compared with those who were not taking an anti-TB treatment. is is supported by a study done in Ethiopia and Tanzania [23,30]. is association between anemia and anti-TB treatment may be due to the fact that TB is the most frequent life-threatening OI and leading cause of death among HIV-infected people.…”

Section: Discussionmentioning

confidence: 85%

Prevalence of Anemia and Its Associated Factors in Antiretroviral-Treated HIV/AIDS-Positive Adults from 2013 to 2018 at Debre Berhan Referral Hospital, Ethiopia

Aynalem

Shiferaw

Woldiye

2020

Advances in Hematology

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Introduction. Anemia was defined as a hemoglobin level of less than or equal to 13.9 g/dl for male and less than or equal to 12.2 g/dl for female adults. It is one of the most common hematological abnormalities in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and is a determining factor for disease progression and death. Among the countries in sub-Saharan Africa, Ethiopia is one of the most affected nations by HIV. Therefore, this study aimed to assess the prevalence of anemia and its associated factors among HIV-positive adults that had received antiretroviral treatment (ART) at Debre Berhan Referral Hospital. Methods. An institution-based, descriptive, cross-sectional study was conducted involving 263 adults with HIV/AIDS that had undergone ART at Debre Berhan Referral Hospital, Ethiopia. Data were collected from patient charts using systematic sampling with a pretested data extraction tool and entered using EpiData 3.1. Variables having a p value ≤0.25 in the bivariate were fitted to a multivariable regression model with a 95% confidence interval. p values ≤0.05 were considered statistically significant in the multivariate analysis. Results. Among the 263 HIV-positive patients, 237 (90.11%) were included in the final analysis. The overall prevalence of anemia was 26.2%. Factors that were significantly associated with anemia were past opportunistic infections, patients being in WHO clinical stage III and IV, and a BMI <18.5. Conversely, those patients who took anti-TB medication were less likely to have anemia. Conclusion. Our study shows that the severity of anemia among HIV/AIDS patients that had undergone ART is lower than most studies conducted in Ethiopia. We also found that opportunistic infection, WHO clinical staging, anti-TB treatment, and low BMI were significantly associated with anemia. Therefore, routine screening of patient nutritional status and opportunistic infections may be useful in predicting and controlling anemia in HIV/AIDS patients.

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“…The World Health Organization (WHO) defines anaemia as a haemoglobin level below 110-120 g/l. 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).…”

Section: Introductionmentioning

confidence: 99%

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

Huibers

Bates

McKew

et al. 2019

Preprint

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Background: Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology is lacking and needed to improve outcomes. Methods:HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes of severe anaemia of anaemia and associations with anaemia severity and mortality were explored.Results: 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. Over two potential causes for anaemia were present in 94% of the patients;including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB-infection (41.2%) andunsuppressed HIV-infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 16 days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2). Conclusion: Mortality among severely anaemic HIV-infected adults is strikingly high.Clinicians must be aware of the urgent need for a multifactorial approach, including starting or optimising HIV treatment; considering TB treatment, nutritional support and attention to potential renal impairment. 109HIV-infected patients with anaemia, especially in resource limiting settings, are scarce. 110Only three of our study patients had confirmed bone marrow malignancies. In contrast 111 MDS was common occurring in 27% of our patients (27, 51). 112Renal impairment was a frequent finding among our study patients and has been 113 linked to HIV disease progression, anaemia and poor outcomes in both wealthy and 114 resource limited settings (52-55). Evaluation of renal function is an important component 115 of severe anaemia treatment protocols (30, 53) since it may affect the choice of ART (52,

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Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Cited by 18 publications

References 25 publications

Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

Prevalence of Anemia and Its Associated Factors in Antiretroviral-Treated HIV/AIDS-Positive Adults from 2013 to 2018 at Debre Berhan Referral Hospital, Ethiopia

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

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