Article Category:
Research Article

Causes and Consequences of Persistent Anemia after 6 Months of Antiretroviral Therapy in Tanzania: An Observational Comparative Cohort Study

Duncan K. Hau Department of Pediatrics, Weill Cornell Medical College, New York, New York;

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Salama Fadhil Mwanza Intervention Trials Unit, Mwanza, Tanzania;

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Myung Hee Lee Center for Global Health, Weill Cornell Medical College, New York, New York;

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Bernard Desderius Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania;

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Megan Willkens Center for Global Health, Weill Cornell Medical College, New York, New York;

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Samuel E. Kalluvya Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania;

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Erius Tebuka Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania;

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Luke R. Smart Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio

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Robert N. Peck Mwanza Intervention Trials Unit, Mwanza, Tanzania;
Center for Global Health, Weill Cornell Medical College, New York, New York;
Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania;

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DOI:
https://doi.org/10.4269/ajtmh.24-0273
Volume/Issue:
Ahead of Print
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Anemia is common among people living with HIV (PLWH), particularly in Africa. Outcomes for PLWH on modern antiretroviral therapy (ART) regimens are not well documented. We conducted an observational study to determine the outcomes and predictors of anemia after ART initiation in Tanzania. We enrolled and followed ART-naïve PLWH and HIV-uninfected individuals at three clinics in Tanzania. We grouped participants into four longitudinal categories based on hemoglobin concentration measured at baseline and 6 months after ART initiation (normal, resolved anemia, incident anemia, and persistent anemia) and followed them for 24 months. There were 991 study participants (494 PLWH, 497 HIV uninfected). After 6 months of ART, 33.9% of PLWH had persistent anemia and 9.9% had incident anemia compared with 12.6% and 9.6% for HIV-uninfected controls. Female sex (adjusted odds ratio [aOR]: 2.62; 95% CI: 1.91–6.75) and low income (aOR: 3.10; 95% CI: 1.36–7.20) were strong predictors of persistent anemia for both PLWH and HIV-uninfected individuals. For PLWH, having a CD4+ T cell count of less than 350 cells/mm3 (aOR: 0.34; 95% Cl: 0.15–0.73) was significantly associated with anemia resolution. Mortality was higher for PLWH who had persistent anemia or incident anemia than for PLWH who had normal hemoglobin or improved anemia (hazard ratio: 4.0, 95% Cl 1.3–12.2). One-third of adults in Tanzania had persistent anemia after 6 months on ART, and persistent anemia was associated with increased mortality. PLWH with persistent or incident anemia after 6 months on modern ART deserve close follow-up, particularly women and low-income adults.

Author Notes

Financial support: This study was supported by R. N. Peck’s NIH R01 HL160332 and K24 HL170902 grants, L. R. Smart’s NIH K23 HL153763 grant, and the Weill Cornell Medicine UL1TR000457 grant.

Disclosures: This study protocol was reviewed and approved by the institutional review boards of Weill Cornell Medicine (1506016328), the Tanzanian National Institute of Medical Research (NIMR/HQ/R.8c/Vol.1/1399), and Bugando Medical Center (CREC/074/2015). All study procedures were performed in accordance with the World Medical Association Declaration of Helsinki. All participants provided written informed consent.

Current contact information: Duncan K. Hau, Department of Pediatrics, Weill Cornell Medical College, New York, NY, E-mail: dkh2001@med.cornell.edu. Salama Fadhil, Mwanza Intervention Trials Unit, Mwanza, Tanzania, E-mail: salama.fadhil@mitu.or.tz. Myung Hee Lee, Megan Willkens, and Robert N. Peck, Center for Global Health, Weill Cornell Medical College, New York, NY, E-mails: myl2003@med.cornell.edu, maw4016@med.cornell.edu, and rnp2002@med.cornell.edu. Bernard Desderius and Samuel E. Kalluvya, Department of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania, E-mails: bm.desderius@gmail.com and samuelkalluvya@yahoo.com. Erius Tebuka, Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania, E-mail: eriust@yahoo.com. Luke R. Smart, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, E-mail: luke.smart@cchmc.org.

Address correspondence to Duncan K. Hau, Weill Cornell Medical College, 525 East 68 St., Box 139, New York, NY 10065. E-mail: dkh2001@med.cornell.edu
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
23 Apr 2024
|
Accepted:
30 Jul 2024
|
Published Online:
29 Oct 2024
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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