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. 2020 Mar 20;20(1):238.
doi: 10.1186/s12879-020-04958-z.

Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

B N Harding  1 , B M Whitney  2 , R M Nance  2 , S A Ruderman  2 , H M Crane  2 , G Burkholder  3 , R D Moore  4 , W C Mathews  5 , J J Eron  6 , P W Hunt  7 , P Volberding  7 , B Rodriguez  8 , K H Mayer  9 , M S Saag  3 , M M Kitahata  2 , S R Heckbert  2 , J A C Delaney  2
Affiliations

Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study

B N Harding et al. BMC Infect Dis. .

Abstract

Background: Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking.

Methods: Within a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010-3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between time-updated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site.

Results: This retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3-7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR.

Conclusion: Because anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.

Keywords: Anemia; Cohort; HIV; Hemoglobin.

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Conflict of interest statement

BNH, BMW, RMN, SAR, RDM, WCM, KHM, MMK, SRH, JACD report grants from the NHLBI during the conduct of the study.

HMC reports grants from NHLBI during the conduct of the study and grants from the NIH, ViiV and PCORI outside the submitted work.

GB reports grants from NHLBI during the conduct of the study, and other fees from Amgen Inc. outside of the submitted work.

JJE reports grants from the NIH during the conduct of the study and grants and personal fees from Gilead Sciences and Viiv and personal fees from Janssen and Merck outside of the submitted work.

PWH reports grants from NHLBI during the conduct of the study, personal fees from Gilead, Viiv and Janssen and non-financial support from Merck outside the submitted work.

PV reports grants from NHLBI during the conduct of the study and other fees from Merck outside the submitted work.

BR reports grants from NHLBI during the conduct of the study and personal fees from Gilead and ViiV outside the submitted work.

MMS reports grants from NHLBI and NAID during the conduct of the study and grants from Gilead, Merck and ViiV Healthcare outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion/exclusion criteria
See this image and copyright information in PMC

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