title: Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group.
abstract: OBJECTIVE
  To describe changes in haemoglobin over time and to determine the joint prognostic value of the current haemoglobin, CD4 lymphocyte count and viral load among patients from across Europe.
  
  
  METHODS
  The analysis included 6725 patients from EuroSIDA, an observational, prospective cohort of patients with HIV from across Europe.
  
  
  METHODS
  Normal haemoglobin was defined as haemoglobin greater than 14 g/dl for men and 12 g/dl for women; mild anaemia was 8-14 g/dl for men and 8-12 g/dl for women; severe anaemia was defined as less than 8 g/dl for both males and females. Linear regression techniques were used to estimate the annual change in haemoglobin; standard survival techniques were used to describe disease progression and risk of death.
  
  
  RESULTS
  At recruitment to the study, 40.4% had normal levels of haemoglobin, 58.2% had mild anaemia and 1.4% had severe anaemia. At 12 months after recruitment, the proportion of patients estimated to have died was 3.1% [95% confidence interval (CI) 2.3-3.9] for patients without anaemia, 15.9% for patients with mild anaemia (95% CI 14.5-17.2) and 40.8% for patients with severe anaemia (95% CI 27.9-53.6; P < 0.0001). In a multivariate, time-updated Cox proportional hazards model, adjusted for demographic factors, AIDS status and each antiretroviral treatment as time-dependent covariates, a 1 g/dl decrease in the latest haemoglobin level increased the hazard of death by 57% [relative hazard (RH) 1.57; 95% CI 1.41-1.75; P < 0.0001], a 50% drop in the most recent CD4 lymphocyte count increased the hazard by 51% (RH 1.51; 95% CI 1.35-1.70; P < 0.0001) and a log increase in the latest viral load increased the hazard by 37% (RH 1.37; 95% CI 1.15-1.63; P = 0.0005).
  
  
  CONCLUSIONS
  Severe anaemia occurred infrequently among these patients but was associated with a much faster rate of disease progression. Among patients with similar CD4 lymphocyte counts and viral load, the latest value of haemoglobin was a strong independent prognostic marker for death.
authors.affiliation: Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
authors.forename: O
authors.initials: O
authors.lastname: Kirk
authors.forename: S E
authors.initials: SE
authors.lastname: Barton
authors.forename: M
authors.initials: M
authors.lastname: Dietrich
authors.forename: R
authors.initials: R
authors.lastname: Proenca
authors.forename: R
authors.initials: R
authors.lastname: Colebunders
authors.forename: C
authors.initials: C
authors.lastname: Pradier
authors.forename: A
authors.initials: A
authors.lastname: dArminio Monforte
authors.forename: B
authors.initials: B
authors.lastname: Ledergerber
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005060:Europe; D005260:Female; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000821:virology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D006454:Hemoglobins