title: Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania.
abstract: OBJECTIVE
  To examine the association of anemia with mortality and disease progression among a cohort of women with HIV in Dar es Salaam, Tanzania.
  
  
  METHODS
  Time to all-cause death, AIDS-related death, and a 50% decrease in CD4 cell count among 1078 HIV-positive pregnant women enrolled in a clinical trial of vitamin supplementation from 1995-2003.
  
  
  RESULTS
  Adjusted models showed that anemia was associated with an increased risk of all-cause mortality (relative hazard [RH]: 2.06, 95% CI: 1.52 to 2.79 for moderate anemia and RH: 3.19, 95% CI: 2.23 to 4.56 for severe anemia) and AIDS-related mortality (RH: 2.21, 95% CI: 1.53 to 3.19 for moderate anemia and RH: 3.47, 95% CI: 2.25 to 5.33 for severe anemia), independent of CD4 cell count, World Health Organization clinical stage, age, pregnancy, vitamin supplementation, and body mass index. Anemia was also associated with a more rapid decline in CD4 counts, measured as time to a 50% drop in CD4 cell count from baseline. Erythrocyte characteristics suggestive of iron deficiency were also associated with all-cause and AIDS-related death and a 50% decline in CD4 cell count.
  
  
  CONCLUSIONS
  Anemia is an independent predictor of mortality and disease progression in this cohort. Screening for anemia, coupled with prevention and treatment efforts, should be included in HIV care initiatives, particularly those that target women.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. meobrien@hsph.harvard.edu
authors.forename: Megan E
authors.initials: ME
authors.lastname: O'Brien
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Elmar
authors.initials: E
authors.lastname: Saathoff
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000740:Anemia / Q000150:complications*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D013636:Tanzania / Q000453:epidemiology
chemical_list: D006454:Hemoglobins