Individuals treated with HAART are no more likely to developed anaemia than treatment-naïve patients according to a US poster presentation at the Second International AIDS Society Conference on HIV Pathogenesis and Treatment in Paris. However, a second US poster at the same conference presented evidence showing that when anaemia does occur it is associated with a poor outcome, particularly if a transfusion is used.
Anaemia was seen in approximately one fifth of HIV-positive people before effective antiretroviral therapy became available. The prevalence of anaemia in the HAART era on its impact on prognosis has been little studied however, according to investigators at the University of South Florida.
They conducted a retrospective chart review of HIV-positive patients who received care at an urban HIV clinic in 2000. Their objectives were to identify the prevalence of anaemia in HAART-treated patients and to see if they could find any risk factors for anaemia.
A total of 758 charts were available for inspection. Average age was a little under 40 years, 70% were men, 50% were African-Americans, mean CD4 cell count was 405 cells/mm3, mean viral load was 78,000 copies, and 633 (84%) patients had been treated with HAART.
Anaemia was diagnosed if a patient had at least one haemoglobin measure of below 12.5g/dL. Mean haemoglobin was 13.7g/dL, but 230 (30.3%) patients were found to be anaemic.
Women were more likely to be anaemic than men (54% versus 20.2%), and African-American women were found to be particularly at risk of developing the condition (66% prevalence).
Patients with a CD4 cell count below 200 cells/mm3 also appeared to be at particular risk of anaemia, with 38.2% having low haemoglobin compared to only 12% of patients with a CD4 cell count above 500 cells/mm3. The same association was found with higher viral loads, with 37.5% of individuals with a viral load above 30,000 copies/mL being anaemic compared to only 16% of patients with undetectable viral loads. An AIDS diagnosis was also predictive of anaemia.
There was no significant difference in the prevalence of anaemia in HAART-treated patients compared to those who received either no treatment or had been pre-treated with antiretroviral drugs.
However, patients treated with a HAART combination containing AZT were significantly more likely to be anaemic than those who received a non-AZT regimen (43.1% versus 19.4%, p<.0001>
The investigators concluded that anaemia was still widespread in the HAART era, and risk factors included low CD4 cell count, higher HIV viral load, being African-American and being a woman. HAART did not increase the risk of anaemia, but taking AZT did.
A second US poster, presented by investigators from Seattle, stated that although the prevalence of anaemia declined with the introduction of HAART, it was associated with a poor prognosis.
The records of 2,408 patients were reviewed between 1996 and 2001. Anaemia was diagnosed as haemoglobin below 10.5g/dL. Investigators found that the prevalence of anaemia fell from 22% in 1996 to 8% in 2001. As in the Florida study, a low CD4 cell count was predictive of anaemia, and the prevalence of low haemoglobin was highest amongst patients with a CD4 cell count below 100 cells/mm3 and remained constant at 29% over time.
Echoing the findings from Florida, HAART was not a risk factor for anaemia, but AZT was.
Amongst the 216 patients with anaemia, 92% had an AIDS diagnosis, average CD4 cell count was 140 cells/mm3 and viral load was 160,00 copies/mL, and 74% had been treated with HAART. Of these patients, 37% died, with patients receiving a blood transfusion having a three-fold increased risk of death, even after adjusting for HAART use, AIDS status, CD4 cell count, viral load and haemoglobin level.
Patients who received epoetin alpha for anaemia did not, however, have an increased risk of death.
The investigators note that even though the prevalence of anaemia has fallen since the use of HAART, it is still common amongst patients with low CD4 cell counts and is associated with a poor outcome, particularly if a patient receives a transfusion. Treatments for anaemia other than transfusion should be explored.
Wills TS. Anemia prevalence among HIV patients: antiretroviral therapy and other risk factors. Antiviral Therapy 8 (suppl.1), abstract 1151, 511, 2003.
Buskin SE et al. Association of treatments for anemia and survival among persons with HIV infection and anemia. Antiviral Therapy 8 (suppl.1), abstract 1154, 511-12, 2003.