Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Paul Petraro Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Christopher Duggan Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Donna Spiegelman Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Ellen Hertzmark Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Abel Makubi Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Guerino Chalamilla Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Helen Siril Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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David Sando Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Said Aboud Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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Wafaie W. Fawzi Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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DOI:
https://doi.org/10.4269/ajtmh.15-0587
Volume/Issue:
Volume 94: Issue 2
Page(s):
384–392
Restricted access
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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% (N = 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.

Author Notes

* Address correspondence to Paul Petraro, Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115. E-mail: paul.petraro@post.harvard.edu

Financial support: This work was supported by the U.S. President's Emergency Plan for AIDS relief (PEPFAR) through the Harvard School of Public Health and by the Ministry of Health and Social Welfare, Tanzania, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD058795).

Authors' addresses: Paul Petraro, Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, E-mail: pvp863@mail.harvard.edu. Christopher Duggan, Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, and Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, E-mail: christopher.duggan@childrens.harvard.edu. Donna Spiegelman, Departments of Nutrition, Biostatistics, and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, E-mail: stdls@hsph.harvard.edu. Ellen Hertzmark, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, E-mail: stleh@channing.harvard.edu. Abel Makubi, Guerino Chalamilla, Helen Siril, David Sando, and Said Aboud, Allied Sciences, Muhimbili University of Health and Allied Sciences, Da es Salaam, Tanzania, E-mails: makubi55@gmail.com, gchalamilla@gmail.com, neemasiril@gmail.com, stdms@channing.harvard.edu, and aboudsaid@yahoo.com. Wafaie W. Fawzi, Departments of Nutrition, Epidemiology, and Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, E-mail: mina@hsph.harvard.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
11 Aug 2015
|
Accepted:
15 Oct 2015
|
Published Online:
03 Feb 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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