Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project

Abstract

To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/μm or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of ≥200 cells/μL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/μL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

Increase of haemoglobin levels by anti‐retroviral therapy is associated with a decrease in immune activation

“…A weak correlation was found between plasma viral load and haemoglobin levels in a study from Luxembourg (33). It is well established that a lower CD4 cell count is associated with lower haemoglobin levels (1,40).…”

Towards a combined prognostic index for survival in HIV infection: the role of ‘non‐HIV’ biomarkers

“…While excellent weighted all cause mortality indices have been established in HIV infection [3,[11][12][13][14], these have focused on HIV markers (CD4 cell count, HIV RNA and AIDSdefining conditions). They have largely omitted biomarkers of anaemia [15][16][17][18], liver disease [8,[19][20][21], and renal disease [22,23] despite their documented association with both immunodeficiency and survival. In this study we used the Veterans Aging Cohort Study (VACS), a sample of over 13 500 veterans initiating cART within the Veterans Affairs Healthcare System (VA), to develop and initially validate the VACS Index, which combines HIV and 'non-HIV' biomarkers.…”

Incidence of anaemia among HIV‐infected patients treated with highly active antiretroviral therapy*

“…Previous studies have demonstrated that patients with HIV infection and low haemoglobin (Hb) levels have a higher mortality risk than less anaemic comparison groups, even after controlling for CD4 cell count and viral load [2,[6][7][8]. Low Hb levels have also been shown to be associated with disease progression to AIDS and with unfavourable outcomes of treatment, such as opportunistic infections and neurological deterioration [2].…”

“…While ZDV has been shown to be associated with anaemia in studies of patients with HIV infection [5,6,[9][10][11], the risk ratio of anaemia for HAART regimens containing ZDV compared with HAART regimens not containing ZDV has not been rigorously established in a US patient cohort. In this retrospective study of HIVinfected out-patients who were not in clinical trials, we computed the incidence of anaemia among patients treated with ZDV and compared the risk of anaemia during ZDV treatment with that of patients treated with HAART regimens that did not contain ZDV.…”