Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;17(10):e806-10.
doi: 10.1016/j.ijid.2013.04.006. Epub 2013 Jun 10.

Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

Torsak Bunupuradah  1 , Azar Kariminia, Kwai-Cheng Chan, Reshmie Ramautarsing, Bui Vu Huy, Ning Han, Revathy Nallusamy, Rawiwan Hansudewechakul, Vonthanak Saphonn, Virat Sirisanthana, Kulkanya Chokephaibulkit, Nia Kurniati, Nagalingeswaran Kumarasamy, Nik Khairulddin Nik Yusoff, Kamarul Razali, Siew Moy Fong, Annette H Sohn, Pagakrong Lumbiganon; TREAT Asia Pediatric HIV Observational Database
Collaborators, Affiliations

Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

Torsak Bunupuradah et al. Int J Infect Dis. 2013 Oct.

Abstract

Background: There are limited data on treatment-related anemia in Asian HIV-infected children.

Methods: Data from Asian HIV-infected children aged <18 years on first-line highly active antiretroviral therapy (HAART) were used. Children who had pre-existing severe anemia at baseline were excluded. Anemia was graded using the United States Division of AIDS (DAIDS) 2004 table. Potential risk factors for severe anemia were assessed by logistic regression.

Results: Data from 1648 children (51.9% female, 62.8% World Health Organization (WHO) stage 3/4) were analyzed. Median (interquartile range) age was 6.8 (3.7-9.6) years, CD4% was 9 (3-16)%, and plasma HIV-RNA was 5.2 (4.7-5.6) log10 copies/ml at HAART initiation in those with available testing. The most common regimens were stavudine/lamivudine/nevirapine (42%) and zidovudine/lamivudine/nevirapine (25%). Severe anemia was identified in 47 (2.9%) children after a median time of 6 months after HAART initiation, with an incidence rate of 5.4 per 100 child-years. Mild anemia or moderate anemia at baseline (p = 0.024 and p = 0.005, respectively), previous or current use of zidovudine (p < 0.0001 and p = 0.013, respectively), and male sex (p = 0.008) were associated with severe anemia. Higher weight-for-age z-score (p = 0.004) was protective.

Conclusions: The incidence of severe anemia in Asian HIV-infected children after HAART initiation was low and mainly occurred during the first few months after HAART initiation. Mild to moderate anemia at baseline and using zidovudine were independent risk factors for the development of severe anemia.

Keywords: Anemia; Antiretroviral therapy; Asia; Pediatric HIV.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Statement: All authors declare no conflict of interest and that members of their immediate families do not have a financial interest in or arrangement with any commercial organization that may have a direct interest in the subject matter of this article.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates of the probability of severe anemia in 1648 children in the first six months of HAART; by anemia status at baseline. HAART, highly active antiretroviral therapy
See this image and copyright information in PMC

References

    1. Calis JC, van Hensbroek MB, de Haan RJ, Moons P, Brabin BJ, Bates I. HIV-associated anemia in children: a systematic review from a global perspective. AIDS (London, England) 2008 Jun 19;22(10):1099–112. - PubMed
    1. Huffam SE, Srasuebkul P, Zhou J, Calmy A, Saphonn V, Kaldor JM, et al. Prior antiretroviral therapy experience protects against zidovudine-related anaemia. HIV medicine. 2007 Oct;8(7):465–71. - PubMed
    1. Volberding PA, Levine AM, Dieterich D, Mildvan D, Mitsuyasu R, Saag M. Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin Infect Dis. 2004 May 15;38(10):1454–63. - PubMed
    1. Semba RD, Martin BK, Kempen JH, Thorne JE, Wu AW. The impact of anemia on energy and physical functioning in individuals with AIDS. Arch Intern Med. 2005 Oct 24;165(19):2229–36. - PubMed
    1. Belperio PS, Rhew DC. Prevalence and outcomes of anemia in individuals with human immunodeficiency virus: a systematic review of the literature. The American journal of medicine. 2004 Apr 5;116(Suppl 7A):27S–43S. - PubMed

Publication types

MeSH terms