HIV patients suffering simultaneously from anaemia and WHO stage 4 HIV disease have a 59% (or greater) chance of dying, even when opportunistic diseases like TB are being treated with antibiotics. The findings, presented at the Fourth South African AIDS Conference in Durban, suggest that anaemia is an independent risk factor that needs to be managed separately from other HIV-associated ailments.
Previous studies have shown that patients suffering from advanced AIDS can have their lives prolonged by treating opportunistic infections with aggressive antibiotic or antifungal treatment and antiretroviral therapy. Co-infected HIV-TB patients who are treated with anti-TB drugs, for example, have a much lower chance of dying (40% death rate) compared to those who don’t take treatment (60% death rate).
Anaemia is a set of symptoms, including fatigue, headaches and shortness of breath, which result from blood haemoglobin levels becoming abnormally low. People with advanced HIV often suffer from anaemia because their bodies can no longer (for a variety of reasons) produce the hormones required to stimulate red blood cell production.
Previous published work from a number of chorts in resource-limited settings has suggested that anaemia, which is not responsive to antibiotics, is a major risk factor for death in people with advanced HIV disease.
The South African research team, working at Settlers Hospital in KwaZulu-Natal, evaluated the impact of anaemia on survival in a South African cohort by collecting data about blood transfusions, haematinics (substances necessary to make red blood cells, such as iron and folic acid) and anti-HIV treatment history from people admitted to the palliative care ward.
The team found that AIDS patients with anaemia suffered a death rate of 59%. This was high compared to patients who died of causes like TB (26% death rate), sepsis (22%), HIVAN, a kidney disease developing with HIV (12%), Kaposi's sarcoma (10%), cancer (7%), dementia (7%) and other diseases (16%).
Furthermore, the average CD4 counts in anaemic patients who died were often similar to non-anaemic patients who lived, leaving doctors to suspect that anaemia, and not opportunistic infection arising from poor immunity, was a major cause of death.
In most cases, blood transfusions and intravenous Venofer (a source of iron) did not seem to reverse the anaemia. Furthermore, the levels of blood ferritin (a protein required to store iron and prevent anaemia) remained unresponsive to treatment, leaving most patients trapped in a high-risk anaemic state.
The findings provide further evidence that anaemia is an independent death-risk factor for patients suffering from advanced AIDS.
The researchers call for more money and resources to be spent on treating anaemia in people with advanced AIDS.
Jamieson C The investigation of the effects of anaemia on the outcome of patients with stage 4 AIDS. Fourth South African AIDS Conference in Durban, South Africa, abstract 408, 2009.