Impact of highly active antiretroviral therapy on anemia and relationship between anemia and survival in a large cohort of HIV-infected women: Women's Interagency HIV Study.
BACKGROUND
Anemia is common in HIV-infected individuals and may be associated with decreased survival.


OBJECTIVE
To ascertain the impact of highly active antiretroviral therapy (HAART) on anemia and the relationship between anemia and overall survival in HIV-infected women.


METHODS
A prospective multicenter study of HIV-1 infection in women. Visits occurred every 6 months, including a standardized history, physical examination, and comprehensive laboratory evaluation. The setting was a university-affiliated clinic at 6 sites in the United States. Participants were 2056 HIV-infected women from the Women's Interagency HIV Study (WIHS). The outcome measure was anemia, defined as hemoglobin (Hb) <12 g/dL. Survival analysis was based on overall mortality during the follow-up period.


RESULTS
Among HIV-infected women who were not anemic at baseline, 47% became anemic by 3.5 years of follow-up. On multivariate analysis, the use of HAART was associated with resolution of anemia even when used for only 6 months (odds ratio [OR] = 1.45; P < 0.05). In the multivariate model, a CD4 cell count <200 cells/microL (OR = 0.56; P < 0.001); HIV-1 RNA level > or =50,000 copies/mL (OR = 0.65; P < 0.001), and mean corpuscular volume (MCV) value <80 fL (OR = 0.40; P < 0.001) were also associated with an inability to correct anemia. Similarly, use of HAART for 12 months or more was associated with a protective effect against development of anemia (OR = 0.71; P < 0.001). Among HIV-infected women, anemia was independently associated with decreased survival (hazard ratio [HR] = 2.58; P < 0.001). Other factors associated with decreased survival included a CD4 cell count <200 cells/microL (HR = 5.83; P < 0.001), HIV-1 RNA level > or = 50,000 copies/mL (HR = 2.12; P < 0.001), and clinical diagnosis of AIDS (HR = 2.83; P < 0.001).


CONCLUSIONS
Anemia is an independent risk factor for decreased survival among HIV-infected women. HAART therapy for as little as 6 months is associated with resolution of anemia.
Berhane
Kiros
K
Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9011, USA. kiros@usc.edu
Karim
Roksana
R
Cohen
Mardge H
MH
Masri-Lavine
Lena
L
Young
Mary
M
Anastos
Kathryn
K
Augenbraun
Michael
M
Watts
D Heather
DH
Levine
Alexandra M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012367:RNA, Viral / Q000032:analysis / Q000097:blood* / Q000235:genetics; D015996:Survival Rate
D019380:Anti-HIV Agents; D012367:RNA, Viral