Journal Article

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

Whitney, B. M., Kitahata, M. M., Delaney, J. A. C., Mayer, K. H., Hunt, P. W., Rodriguez, B., Saag, M. S., Harding, B. N., Burkholder, G., Volberding, P., Ruderman, S. A., Mathews, W. C., Eron, J. J., Moore, R. D., Heckbert, S. R., Nance, R. M., Crane, H. M.

2020

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / Adult / Age / AIDS / Alcohol use / Anemia / Anemia - epidemiology / Anemia - etiology / Anti-Retroviral Agents - adverse effects / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Blood & organ donations / Body mass index / Body size / CD4 antigen / CD4 Lymphocyte Count / Cohort / Cohort analysis / Coinfection - complications / Comorbidity / Drinking (Alcoholic beverages) / Drug use / Electronic health records / Epidermal growth factor receptors / Ethnicity / Female / Follow-Up Studies / Glomerular Filtration Rate / Glycosylated hemoglobin / Health / Health aspects / Hemoglobin / Hemoglobins / Hemoglobins - analysis / Hepatitis / Hepatitis C / Hepatitis C - complications / Hepatitis C virus / Highly active antiretroviral therapy / HIV / HIV and co-infections / HIV infections / HIV Infections - blood / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - virology / HIV patients / Human immunodeficiency virus / Humans / Incidence / Infection / Infectious Diseases / Internal Medicine / Laboratories / Load distribution / Male / Measurement / Medical Microbiology / Medical records / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Parasitology / Patients / Physiological aspects / Prospective Studies / Race / Regression analysis / Research Article / Retrospective Studies / Risk analysis / Risk Factors / Sensitivity analysis / Sex / Sexually transmitted diseases / STD / Studies / Substance-Related Disorders - complications / Time / Tropical Medicine / United States - epidemiology / Viral Load / Viruses