title: Current hemoglobin levels are more predictive of disease progression than hemoglobin measured at baseline in patients receiving antiretroviral treatment for HIV type 1 infection.
abstract: The role of hemoglobin levels as an independent prognostic marker of progression to AIDS and/or death in HIV-infected patients starting combination antiretroviral therapy (cART) was investigated. A total of 2,579 patients from the EuroSIDA cohort with hemoglobin, CD4 cell count, and HIV RNA viral load measured 6 months prior to starting cART was included in the analyses. Anemia was defined as mild (<or=14 g/dl males, <or=12 g/dl females) and severe (<8 g/dl both genders). Poisson regression was used to determine factors related to clinical progression (new AIDS/death). Hemoglobin levels increased by a median of +0.48 g/dl (IQR -0.4 to +1.3) in the first year of cART. During 14,272 person years of follow-up (PYFU) there were 505 new AIDS/deaths. Of the patients 304 (11.8%) developed mild and 19 severe anemia (0.7%). In multivariate analysis baseline hemoglobin was significantly associated with progression to AIDS/death after starting cART with an IRR of 1.07 per 1 g/dl lower (95% CI 1.01-1.13; p = 0.023). When hemoglobin was fitted as a time-updated variable the IRR increased to 1.36 per 1 g/dl lower (95% CI 1.30-1.42; p < 0.001). Starting cART was associated with an increase in hemoglobin levels. Lower hemoglobin values, particularly the latest measured, were associated with an increased risk of disease progression.
authors.affiliation: Hospital for Infectious Diseases, Warsaw, Poland. jkowalska@cdit-aids.med.pl
authors.forename: Justyna D
authors.initials: JD
authors.lastname: Kowalska
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Anders
authors.initials: A
authors.lastname: Blaxhult
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Jan
authors.initials: J
authors.lastname: van Lunzen
authors.forename: Daria
authors.initials: D
authors.lastname: Podlekareva
authors.forename: Ann-Brit Eg
authors.initials: AB
authors.lastname: Hansen
authors.forename: Ladislav
authors.initials: L
authors.lastname: Machala
authors.forename: Israel
authors.initials: I
authors.lastname: Yust
authors.forename: Thomas
authors.initials: T
authors.lastname: Benfield
mesh_terms: D000328:Adult; D000740:Anemia; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins