1921
Volume 94, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Anemia is often a comorbidity of human immunodeficiency virus (HIV) infection. Many cross-sectional studies have been conducted on anemia and HIV, but few, if any, have addressed incidence of anemia prospectively. A longitudinal analysis was conducted in 48,068 nonpregnant HIV-infected adults in Dar es Salaam, Tanzania, seen at Management and Development for Health–U.S. President's Emergency Plan for AIDS Relief HIV care and treatment programs between 2004 and 2011. Almost 56% ( = 27,184) of study participants had anemia (hemoglobin < 11 g/dL) at the time of enrollment at the clinic. Female gender, low body mass index (BMI), low CD4 T-cell count, high levels of liver enzyme alanine aminotransferase, antiretroviral treatment (ART) regimens, and concurrent tuberculosis treatment were all independently significantly associated with an increased risk of anemia. Low BMI and low CD4 T-cell count were independently significantly associated with an increased risk for iron deficiency anemia (IDA). Higher BMI status and ART use were associated with recovery from anemia. Anemia, including IDA, is a comorbidity that is associated with other adverse consequences (e.g., low BMI and CD4 T-cell count) among individuals with HIV infection, including those on ART. Interventions to prevent anemia and its complications need to be examined in the context of future studies.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.15-0587
2016-02-03
2017-11-19
Loading full text...

Full text loading...

/deliver/fulltext/14761645/94/2/384.html?itemId=/content/journals/10.4269/ajtmh.15-0587&mimeType=html&fmt=ahah

References

  1. Government of Tanzania, 2012. HIV/AIDS in Tanzania. Available at: http://www.tanzania.go.tz/home/pages/2245. Accessed November 12, 2015.
  2. UNICEF, 2012. United Republic of Tanzania Statistics, 2010. Available at: www.unicef.org/infobycountry/tanzania_statistics.html. Accessed February 2, 2012.
  3. Uneke CJ, Duhlinska DD, Igbinedion EB, , 2007. Prevalence and public-health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in southeastern Nigeria. J Health Popul Nutr 25: 328335.
  4. Buskin SE, Sullivan PS, , 2004. Anemia and its treatment and outcomes in persons infected with human immunodeficiency virus. Transfusion 44: 826832.[Crossref]
  5. Wilson MG, Chambers L, Bacon J, Rueda S, Ragan M, , 2010. Issues of comorbidity in HIV/AIDS: an overview of systematic reviews. Toronto, ON: Ontario HIV Treatment Network.
  6. Smith RE, Jr, 2010. The clinical and economic burden of anemia. Am J Manag Care 16 (Suppl): S59S66.
  7. O'Brien ME, Kupka R, Msamanga GI, Saathoff E, Hunter DJ, Fawzi WW, , 2005. Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania. J Acquir Immune Defic Syndr 40: 219225.[Crossref]
  8. Johannessen A, Naman E, Ngowi BJ, Sandvik L, Matee MI, Aglen HE, Gundersen SG, Bruun JN, , 2008. Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania. BMC Infect Dis 8: 52.[Crossref]
  9. Volberding PA, Levine AM, Dieterich D, Mildvan D, Mitsuyasu R, Saag M, , 2004. Anemia in HIV infection: clinical impact and evidence-based management strategies. Nephrol Dial Transplant 38: 14541463.
  10. Kreuzer KA, Rockstroh JK, , 1997. Pathogenesis and pathophysiology of anemia in HIV infection. Ann Hematol 75: 179187.[Crossref]
  11. Moore RD, Forney D, , 2002. Anemia in HIV-infected patients receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr 29: 5457.[Crossref]
  12. Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, Cohen M, Anastos K, Newman M, Gange SJ, Watts H, , 2001. Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J Acquir Immune Defic Syndr 26: 2835.[Crossref]
  13. Semba RD, Shah N, Klein RS, Mayer KH, Schuman P, Vlahov D, , 2002. Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and -uninfected women. Nephrol Dial Transplant 34: 260266.
  14. Finkelstein JL, Mehta S, Duggan CP, Spiegelman D, Aboud S, Kupka R, Msamanga GI, Fawzi WW, , 2011. Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections. Public Health Nutr 15: 928937.[Crossref]
  15. Chalamilla G, Hawkins C, Okuma J, Spiegelman D, Aveika A, Christian B, Koda H, Kaaya S, Mtasiwa D, Fawzi W, MDH Tanzania HIV/AIDS Program; , 2011. Mortality and treatment failure among HIV-infected adults in Dar es Salaam, Tanzania. J Int Assoc Physicians AIDS Care 11: 296304.[Crossref]
  16. Hawkins C, Chalamilla G, Okuma J, Spiegelman D, Hertzmark E, Aris E, Ewald T, Mugusi F, Mtasiwa D, Fawzi W, , 2011. Sex differences in antiretroviral treatment outcomes among HIV-infected adults in an urban Tanzanian setting. AIDS 25: 11891197.[Crossref]
  17. World Health Organization, 2006. Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization.
  18. The United Republic of Tanzania Ministry of Health and Social Welfare, 2008. National Guidelines for the Management of HIV and AIDS, 3rd edition. National AIDS Control Programme (NACP), Tanzania Ministry of Health, Dar es Salaam.
  19. Cox DR, , 1972. Regression models and life tables. J R Stat Soc Series B Stat Methodol 34: 187220.
  20. Andersen PK, Gill RD, , 1982. R. D. Cox's regression model counting process: a large sample study. Ann Stat 10: 11001120.[Crossref]
  21. Durrleman S, Simon R, , 1989. Flexible regression models with cubic splines. Stat Med 8: 551561.[Crossref]
  22. Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW, , 1998. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 91: 301308.
  23. Lewis S, Bain B, Bates I, , 2006. Dacie and Lewis: Practical Haematology, 10th edition. Philadelphia, PA: Elsevier.
  24. Lewis SM, Dacie JV, , 1984. Practical Haematology, 6th edition. London, UK: Churchill Livingstone.
  25. Rozenburg G, , 2003. Microscopic Haematology. A Practical Guide for the Laboratory. London, UK: Churchill Livingstone.
  26. Lundgren JD, Mocroft A, Gatell JM, Ledergerber B, D'Arminio Monforte A, Hermans P, Goebel FD, Blaxhult A, Kirk O, Phillips AN, EuroSIDA Study Group; , 2002. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study. J Infect Dis 185: 178187.[Crossref]
  27. Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, Colebunders R, Pradier C, D'Arminio Monforte A, Ledergerber B, Lundgren JD, , 1999. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group. AIDS 13: 943950.[Crossref]
  28. Dainiak N, Worthington M, Riordan MA, Kreczko S, Goldman L, , 1988. 3′-Azido-3′-deoxythymidine (AZT) inhibits proliferation in vitro of human haematopoietic progenitor cells. Br J Haematol 69: 299304.[Crossref]
  29. Richman DD, Fischl MA, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, Leedom JM, Groopman JE, Mildvan D, Hirsch MS, , 1987. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 317: 192197.[Crossref]
  30. Johansson KA, Robberstad B, Norheim OF, , 2010. Further benefits by early start of HIV treatment in low income countries: survival estimates of early versus deferred antiretroviral therapy. AIDS Res Ther 7: 3.[Crossref]
  31. Kupka R, Msamanga GI, Mugusi F, Petraro P, Hunter DJ, Fawzi WW, , 2007. Iron status is an important cause of anemia in HIV-infected Tanzanian women but is not related to accelerated HIV disease progression. J Nutr 137: 23172323.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0587
Loading
/content/journals/10.4269/ajtmh.15-0587
Loading

Data & Media loading...

  • Received : 11 Aug 2015
  • Accepted : 15 Oct 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error