Anemia and its treatment and outcomes in persons infected with human immunodeficiency virus.
BACKGROUND
Anemia is a common comorbidity with HIV. Before the highly active antiretroviral therapy (HAART) era, anemia was found to be associated with decreased survival. This study examined the prevalence of anemia since HAART's availability and the associations between anemia treatments and survival.


METHODS
Anemia prevalence in a cohort of HIV-infected persons was described. In a smaller cohort of HIV-infected anemic patients, survival was modeled with a time-dependent proportional hazards regression model adjusting for CD4+ T-lymphocyte count, plasma HIV RNA concentration load, hemoglobin (Hb) level, and other factors.


RESULTS
Anemia (Hb level < 10.5 g/dL, or physician diagnosis) decreased from 13 to 5 percent (p < 0.05) in 1996 through 2001. Anemia prevalence was highest (24-35%) and did not decrease among patients with CD4 count less than 100 cells per mL. In total, 216 severely anemic HIV-infected individuals (mean Hb level, 8.1 g/dL) followed for a median of 13 months had a 37-percent mortality rate. Of these, 22 percent were untreated (13% mortality rate), 42 percent received transfusion alone (52% mortality), 12 percent received epoetin alfa alone (19% mortality), and 24 percent received both (47% mortality). Transfusion was associated with a threefold excess mortality risk, but epoetin alfa prescription was not associated with mortality.


CONCLUSIONS
The prevalence of anemia decreased in the HAART era, and transfusion was positively associated with risk of death, suggesting limiting use of transfusions in nonemergency situations.
Buskin
Susan E
SE
Public Health--Seattle & King County and the Fred Hutchinson Cancer Research Center, Seattle, Washington 98104, USA. susan.buskin@metrokc.gov
Sullivan
Patrick S
PS
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D023241:Antiretroviral Therapy, Highly Active; D001803:Blood Transfusion; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003131:Combined Modality Therapy; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011994:Recombinant Proteins; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load; D014861:Washington / Q000453:epidemiology
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa