Prevalence of anemia among people living with HIV: A systematic review and meta-analysis

Abstract

Background Anemia is the most frequent hematologic abnormality among people living with human immunodeficiency virus (HIV) (PLWHIV) and is associated with HIV disease progression and higher risk of mortality of the patients. However, there is a wide variation of the prevalence of anemia among PLWHIV in different clinical settings. We aimed to obtain more precise estimates of prevalence of anemia and severity of anemia among PLWHIV, which may be important for patients, caregivers, researchers and health policy-makers.Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for original articles reporting the prevalence of anemia defined using age and sex-specific hemoglobin levels according to World Health Organization criteria among PLWHIV from inception to August 31, 2021. We used DerSimonian-Laird randomeffects meta-analyses to obtain pooled prevalence and 95% confidence intervals (CIs) of anemia and severity of anemia among PLWHIV. A univariable meta-regression has been conducted to assess the association between anemia prevalence and study characteristics, including study design, median year of sampling, geographical region, World Bank Income level, and proportion of antiretroviral therapy (ART). FindingsWe included 63 observational studies covering 110,113 PLWHIV. The pooled prevalence of anemia was 39.7% (95% CI: 31.4%-48.0%) for children living with HIV aged <15 years, 46.6% (95% CI: 41.9%-51.4%) for adults (men and non-pregnant women) living with HIV aged ≥15 years, and 48.6% (95% CI: 41.6%-55.6%) for pregnant women living with HIV. Among adults living with HIV, the pooled prevalence of severity of anemia was 21.6% (95% CI: 19.9%-23.3%), 22.6% (95% CI: 14.8%-30.4%), and 6.2% (95% CI: 4.4%-8.1%) for mild, moderate and severe anemia, respectively. Compared with East Africa, anemia prevalence among adults living with HIV was higher in Southern Africa (p = 0.033).Interpretation Anemia is prevalent among PLWHIV. Thus, policies, strategies, and programs should be considered to identify the predictors of anemia among PLWHIV to reduce the burden of anemia among patients in the ART era.

Pattern of CD4 Count and Hematological Indices in HIV Serodiscordant Partners in Jos North Local Government Area of Plateau State, Nigeria

“…Several studies have documented anemia in HIV infected individuals indicated by significantly lower mean levels of RBC, Hb and PCV [24,1]. The most prevalent hematologic abnormality among HIV-positive individuals is anemia, which is also linked to the course of the disease and a higher mortality risk for the patients [42]. Patients with HIV experience anemia for a variety of reasons.…”

Long-Term Zidovudine Therapy and Whether It is a Trigger of Vitamin B12 Deficiency: A Case Study of Megaloblastic Anemia at the University of Zambia Teaching Hospital

“…Macrocytic anemia is broadly classified as [1] megaloblastic associated with vitamin B12 and folate deficiency and [2] the nonmegaloblastic moiety associated with chronic alcoholism, liver disease, hypothyroidism, hereditary spherocytosis, and states of increased red cell consumption such as hemolysis or high turnover in pregnancy [21].…”

“…Anemia is a frequent hematological complication of human immunode ciency virus (HIV) infection, and its incidence is adversely associated with advanced HIV disease, poor treatment outcomes, and increased risk of patient mortality [1,2]. Although the causes of anemia in the general population are multifactorial in origin with various pathophysiological mechanisms, the most common etiology globally is iron de ciency, among other nutritional deciencies such as folic acid and vitamin B12 [1].…”

“…Although the burden of anemia among persons living with HIV in Zambia has not been fully established, a recent study by Cao et al reported that the prevalence of anemia among adults living with HIV was higher in Southern Africa than that in East Africa. Furthermore, anemia in HIV infection was common among all groups in the population [2] and was higher in advanced HIV disease, among women, infants, and children in developing countries [7,8]. Other factors, including socioeconomic factors, marital status, monthly income, and educational status, in uence the severity of anemia among persons living with HIV [9].…”

SARS-CoV-2 Infection Is Associated with Uncontrolled HIV Viral Load in Non-Hospitalized HIV-Infected Patients from Gugulethu, South Africa

“…By univariate analysis, we detected a significant association between SARS-CoV-2 serology status and elevated (>1000 copies/mL) HIV VL (31.4% versus 14.6% uncontrolled HIV VL in SARS-CoV-2 seropositive versus seronegative patients, p = 0.04, Figure 2), sodium concentration (45.6% below normal range in SARS-CoV-2 seropositive (range 128-144 mmol/L) versus 27.9% in seronegative patients (range 134-143 mmol/L), p = 0.047), mean corpuscular hemoglobin as a measure for oxygen (8.7% versus 0% below normal range in SARS-CoV-2 seropositive versus seronegative patients, p = 0.048), monocyte count (0% versus 6.8% above normal range in SARS-CoV-2 seropositive versus seronegative patients, p = 0.029), CD45+ white cell count (0% versus 4.8% above normal range in SARS-CoV-2 seropositive versus seronegative patients, p = 0.041) and CD4 percentage of lymphocytes (96.1% versus 83.3% below normal range in SARS-CoV-2 seropositive versus seronegative patients, p = 0.014). Interestingly, in addition to uncontrolled HIV VL, hyponatremia and anemia are indicative of HIV disease severity [26,27], as well as of adverse COVID-19 disease outcome [5,13,28,29].…”