Prevalence, incidence and predictors of severe anaemia with zidovudine-containing regimens in African adults with HIV infection within the DART trial.
OBJECTIVE
To describe the prevalence, incidence and predictors of severe anaemia in previously untreated symptomatic HIV-infected adults with CD4+ T-cells <200 cells/mm(3) initiating zidovudine-containing regimens in Africa.


METHODS
DART is a randomized trial comparing two strategies for HIV/AIDS management in Uganda and Zimbabwe.


METHODS
We analysed the occurrence of anaemia at weeks 4 and 12, and then every 12 weeks. We also evaluated sex, age, WHO stage, body mass index (BMI), baseline laboratory measurements and first regimen as predictors of developing grade 4 anaemia (<6.5 mg/dl) by week 48 using logistic regression.


RESULTS
To May 2005, 3,314 participants (65% women, 23% at WHO stage 4, median age=37 years, baseline CD4+ T-cell=86 cells/mm(3) and median baseline haemoglobin=11.4 g/dl) had a median 72 weeks follow-up. Prevalence of grade 4 anaemia was 0.70, 2.0%, 0.5% and <0.5% at weeks 4, 12, 24 and > or =36, respectively. Overall, 219 (6.6%) participants developed grade 4 anaemia by week 48; women and those with lower haemoglobin, CD4+ T-cell count and BMI at baseline were at significantly higher risk (P<0.05), but not those with lower neutrophils or receiving cotrimoxazole at baseline.


CONCLUSIONS
We observed a higher incidence of grade 4 anaemia than in studies from industrialized countries, which is likely to be due in part to population characteristics and in part to a higher rate of concurrent HIV-related clinical events. Clinical vigilance and haemoglobin measurements 4, 8 and 12 weeks after starting zidovudine could help to manage serious anaemia.
Ssali
Francis
F
Joint Clinical Research Centre, Kampala, Uganda.
Stöhr
Wolfgang
W
Munderi
Paula
P
Reid
Andrew
A
Walker
A Sarah
AS
Gibb
Diana M
DM
Mugyenyi
Peter
P
Kityo
Cissy
C
Grosskurth
Heiner
H
Hakim
James
J
Byakwaga
Helen
H
Katabira
Elly
E
Darbyshire
Janet H
JH
Gilks
Charles F
CF
D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D014454:Uganda / Q000453:epidemiology; D015215:Zidovudine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015030:Zimbabwe / Q000453:epidemiology
D019380:Anti-HIV Agents; D006454:Hemoglobins; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine