Haemoglobin recovery among HIV-1 infected patients on zidovudine-based antiretroviral therapy and other regimens in north-central Nigeria

Abstract

Objective To assess trends in hemoglobin recovery among HIV-infected patients initiated on zidovudine-based combined antiretroviral therapy (cART) stratified by baseline hemoglobin level. Methods Hemoglobin data from non-pregnant adult patients initiating cART in rural north-central Nigeria between June 2009 and May 2011 was analyzed using a linear mixed effects model to assess the interaction between time, zidovudine-containing regimen, and baseline hemoglobin level on the outcome of subsequent hemoglobin level. Best fit curves were created for baseline hemoglobin in the 10th, 25th, 75th and 90th percentiles. Results We included 313 patients with 736 measures of hemoglobin in the analysis (239 on zidovudine and 74 on non-zidovudine-containing regimens). Median hemoglobin increased over time in both groups, with differences in hemoglobin response over time related to baseline hemoglobin levels and zidovudine use (p = 0.003). The groups of patients on zidovudine at the 10th and 90th percentiles had downward sloping curves while all other groups had upward trending hemoglobin levels. Conclusion Though hemoglobin levels increased overall for patients on zidovudine-containing regimens, for those in the 10th and 90th percentiles hemoglobin levels trended downward over time. These results have implications for decisions regarding when to initiate, switch from or avoid the use of zidovudine.

Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

“…23, 24 North-central Nigeria is a region of the country with an adult HIV prevalence of 7.5% compared to the national HIV prevalence of 3.6%. 25 The prevalence of HIV among pregnant women in Niger and Kwara states is estimated to be 4.0% and 2.2%, respectively.…”

Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa

“…In this patient population, which included patients who were ART-naive and those receiving ART, 85% had anemia, and the prevalence of severe or life-threatening anemia was more than 30%. Previous studies in sub-Saharan Africa have also reported a similarly high prevalence of HIV-related anemia, sometimes approaching as high as 90% [ 3 , 5 , 6 , 32 ]; however, such estimates are largely derived among ART-naive, ambulatory outpatients. The high prevalence of severe or life-threatening anemia observed in this study was in part due to the inclusion of patients ill enough to seek acute medical attention, as well as advanced HIV/AIDS disease, and a high rate of opportunistic infections, notably TB.…”

“…Despite the unprecedented scale-up of antiretroviral therapy (ART) in sub-Saharan Africa over the last decade, morbidity and mortality among hospitalized inpatient persons infected with human immunodeficiency virus (HIV) remain very high [ 1 , 2 ]. Anemia is the most common hematological complication of HIV disease, it is highly prevalent among persons living with HIV/acquired immune deficiency syndrome (AIDS) in sub-Saharan Africa [ 3 – 6 ], and it may be an important driver of morbidity and mortality among inpatients infected with HIV. HIV-related anemia is associated with fatigue, decreased quality of life [ 7 ], and a greatly increased mortality risk [ 8 – 11 ].…”

“…ART is associated with substantial hemoglobin recovery, resulting in resolution of anemia in a majority of HIV-infected African patients without additional specific hematological interventions [ 3 , 5 , 6 , 13 , 14 ]. ART is thus the key therapeutic intervention for HIV-related chronic anemia, but weeks or months may be required for adequate hemoglobin recovery to occur with ART.…”

Enrolment trends in a comprehensive HIV programme in rural north-central Nigeria: improved care indices, but declining quality of clinical data over time

“…This finding is problematic, as CD4z cell count is a determining factor in ART initiation, 18,19 and haemoglobin testing is important in establishing the presence of anaemia, a common side effect of ZDV-containing regimens (a standard regimen in our population). 20,21 We posit possible explanations for this finding. First, changes in programme leadership in the second year of the programme likely reduced the intensity of logistics coordination for laboratory testing, including CD4z cell count and haemoglobin.…”