Incidence and predictors of recovery from anaemia within an HIV-infected South African Cohort, 2004-2010

Abstract

Introduction: Anaemia is one of the most frequent haematological complications in HIV-infected  persons. Understanding factors associated with recovery from anaemia during ART is vital in improving clinical outcomes since anaemia is a strong predictor of mortality.

Methods: Cohort study of 12,441 HIV-infected adults initiating ART between 2004- 2010 in Johannesburg, South Africa. A further 2,489 patients with prevalent anaemia at ART initiation were examined to  determine the incidence and predictors of recovery from anaemia. Cox proportional hazards models were fitted to investigate predictors of recovery from anaemia.

Results: Of the 2,489 patients with prevalent anaemia, most patients (n=2,225, 89.4%) recovered from anaemia. Median time to anaemia recovery was 3.9 months (IQR: 3.22-6.20) and incidence rate was 180 per 100person years (95% CI: 172-187). In univariate analysis, sex, CD4 count, BMI, WHO stage,  employment status, smoking status and presence of tuberculosis at initiation of ART were significant  predictors of recovery from anaemia. However in multivariate analysis, predictors of recovery from  anaemia were: male sex- HR: 1.43 (95% CI: 1.29-1.59) p< 0.001, advanced WHO stage III/IV - HR: 1.17 (95% CI: 1.07-1.29) p=0.001). There was no significant association with CD4 count in multivariate  analysis.

Conclusion: A large proportion of HIV infected patients with anaemia at baseline recover early during the course of ART. Females and those with less advanced WHO stage seem to be at higher risk of poor  recovery from anaemia. Understanding the predictors for poor recovery from anaemia would allow closer follow-up and more targeted interventions thus reducing excess anaemia and mortality burden.

Key words: Haemoglobin, human immunodeficiency virus, AIDS, Themba Lethu clinical cohort, antiretroviral therapy