Long-term safety and efficacy of zidovudine in patients with advanced human immunodeficiency virus disease. Zidovudine Epidemiology Study Group

Rd, Moore; Creagh-Kirk, Terri; Keruly, Jeannie C.; Link, G; Mc, Wang; Richman, Douglas D.; Re, Chaisson

doi:10.1001/archinte.151.5.981

Cited by 17 publications

(11 citation statements)

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“…Accordingly, current guidelines for the management of HCV in HIV‐infected persons recommend the use of weight‐based RBV dosing (1000–1200 mg/day) for genotype 1 infection [18–20]. Yet, the RBV dose approved by the US Food and Drug Administration for use in such patients is 800 mg/day and the safety of weight‐based RBV dosing has not been adequately studied, particularly in coinfected patients receiving concurrent ZDV‐base ART which may augment RBV‐induced anaemia [16,17,21]. Our findings provide important clinical data regarding the safety of higher weight‐based RBV dosing and concurrent ZDV use in HIV‐infected patients; accordingly, several points are noteworthy.…”

Section: Discussionmentioning

confidence: 94%

Zidovudine use but not weight‐based ribavirin dosing impacts anaemia during HCV treatment in HIV‐infected persons

Alvarez

Dieterich

Bräu

et al. 2006

Journal of Viral Hepatitis

113

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Anaemia during peginterferon (PEG-IFN) and ribavirin (RBV) therapy is common in human immunodeficiency virus/hepatitis C virus (HIV/HCV)-coinfected patients despite the use of lower doses of RBV than are recommended for HIV-seronegative persons. In addition, concurrent zidovudine (ZDV) may exacerbate the anaemia caused by PEG-IFN and RBV. We retrospectively analysed the incidence of anaemia, RBV dose reduction and epoetin-alpha (EPO) use among coinfected patients treated with PEG-IFN and weight-based RBV (800-1400 mg/day) who enrolled in two clinical trials and had haemoglobin (Hb) levels assessed at baseline and after 4 and/or 12 weeks of HCV treatment. Overall, 217 patients were included; pre-treatment Hb levels (mean 14.7 g/dL) were similar in all patients, including ZDV users (29% of patients). After 4 weeks of therapy, the mean Hb decline was greater among ZDV recipients (3.13 g/dL) compared with those on other anti-retroviral treatment (ART) (2.13 g/dL) or on no ART (1.47 g/dL) (P < 0.0001). RBV dose reduction and EPO use were more common in patients taking ZDV compared with those not taking ZDV (P < 0.0001). RBV dose was not associated with Hb reduction, RBV dose reduction or EPO use. Virologic response after 12 weeks of therapy and the treatment discontinuation rate did not differ by ZDV use. The use of ZDV but not weight-based RBV dosing was associated with an increased risk of anaemia, RBV dose reduction or EPO use in coinfected patients treated with PEG-IFN/RBV. However, ZDV use was not associated with higher rates of treatment discontinuation or lower early virologic response rates. HIV and hepatitis C care providers should be cognizant of these data.

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Section: Discussionmentioning

confidence: 94%

Zidovudine use but not weight‐based ribavirin dosing impacts anaemia during HCV treatment in HIV‐infected persons

Alvarez

Dieterich

Bräu

et al. 2006

Journal of Viral Hepatitis

113

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“…Moreover, anemia can impact HIV disease progression, treatment options, and mortality. Several studies [18] , [19] , [20] have indicated that among individuals with HIV, anemia is associated with HIV progression to AIDS. Furthermore, HIV patients with anemia are at a greater risk of mortality compared to their non-anemic counterparts, even after controlling for CD4+ cell count and viral load [4] , [21] .…”

Section: Introductionmentioning

confidence: 99%

HIV Symptom Burden and Anemia among HIV-Positive Individuals: Cross-Sectional Results of a Community-Based Positive Living with HIV (POLH) Study in Nepal

2014

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BackgroundPrevious research has reported high rates of anemia in people living with HIV/AIDS (PLWHA) in hospital or tertiary care settings. The objective of this community-based study was to measure the prevalence of anemia and describe the risk factors, with a specific emphasis on HIV symptom burden, in PLWHA in the Kathmandu Valley, Nepal.MethodsWe conducted a cross-sectional survey of 319 PLWHA residing in the Kathmandu Valley, Nepal. We recruited participants from five non-governmental organizations in the Kathmandu Valley. Descriptive statistics and multivariable logistic regression analyses were used.ResultsOur study found a 55.8% prevalence of anemia in PLWHA in the Kathmandu Valley. The prevalence of anemia among the participants with first, second, third, and fourth quartiles of HIV symptom burden was 44.8%, 49.3%, 60.3%, and 69.6%, respectively. Compared to the participants with lowest level of HIV symptom burden, the participants with highest level of HIV symptom burden were more likely to have anemia (adjusted odds ratio = 2.14; 95% confidence interval = 1.07 to 4.30).ConclusionDue to a high prevalence of anemia in a community-based sample of PLWHA, HIV patients should be counseled on their risk of developing anemia and encouraged to seek timely care for HIV symptoms.

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“…4 Clinical consequences associated with HIV-associated anaemia include severe fatigue, 5 poorer quality of life for PLWH 6,7 and possibly an increased rate of HIV disease progression. 2,8,9 Anaemia is independently associated with increased mortality risk 10,11 and remains a common problem among ART-naïve patients in sub-Saharan Africa. 12 …”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Anemia for Tuberculosis in HIV-Infected Patients in Sub-Saharan Africa

Kerkhoff

Wood

Vogt

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The relationship between anaemia and undiagnosed tuberculosis (TB) in patients living with HIV in sub-Saharan Africa is incompletely defined. We assessed the prevalence of TB among those with HIV-related anaemia and evaluated new means of rapid TB diagnosis. Methodology Blood haemoglobin levels were measured in unselected antiretroviral treatment (ART)-naïve patients in Cape Town, South Africa, and anaemia was classified according to WHO criteria. All patients were screened for TB by testing paired sputum samples using liquid culture (reference standard), fluorescence microscopy and Xpert MTB/RIF. Urine samples were tested for lipoarabinomannan (LAM) using the Determine TB-LAM diagnostic assay. Results Of 602 adults screened, 485 had complete results. Normal haemoglobin levels were found in 44.5% (n=216) of patients and mild, moderate or severe anaemia were present in 24.9% (n=121), 25.4% (n=123) and 5.2% (n=25) of patients, respectively. Culture-confirmed pulmonary TB was diagnosed in 8.8% (19/216) of those without anaemia compared to 16.5% (20/121), 26.0% (32/123) and 40.0% (10/25) with mild, moderate or severe anaemia, respectively (p<0.001). Anaemia was a strong independent predictor of TB. The sensitivities of diagnostic assays were much higher among those with moderate/severe anaemia compared to those with no/mild anaemia using sputum microscopy (42.9% vs 15.4%); urine LAM (54.8% vs 0%); sputum microscopy plus urine LAM (71.4% vs 15.4%) and sputum Xpert (73.8% vs 41.0%) (P<0.01 for all). Conclusions A very high prevalence of undiagnosed TB was found in patients with moderate or severe anaemia. Such patients should be prioritized for routine microbiological investigation using rapid diagnostic assays.

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Long-term safety and efficacy of zidovudine in patients with advanced human immunodeficiency virus disease. Zidovudine Epidemiology Study Group

Cited by 17 publications

References 0 publications

Zidovudine use but not weight‐based ribavirin dosing impacts anaemia during HCV treatment in HIV‐infected persons

Zidovudine use but not weight‐based ribavirin dosing impacts anaemia during HCV treatment in HIV‐infected persons

HIV Symptom Burden and Anemia among HIV-Positive Individuals: Cross-Sectional Results of a Community-Based Positive Living with HIV (POLH) Study in Nepal

Predictive Value of Anemia for Tuberculosis in HIV-Infected Patients in Sub-Saharan Africa

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