title: Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy.
abstract: BACKGROUND
  There are limited data on treatment-related anemia in Asian HIV-infected children.
  
  
  METHODS
  Data from Asian HIV-infected children aged <18 years on first-line highly active antiretroviral therapy (HAART) were used. Children who had pre-existing severe anemia at baseline were excluded. Anemia was graded using the United States Division of AIDS (DAIDS) 2004 table. Potential risk factors for severe anemia were assessed by logistic regression.
  
  
  RESULTS
  Data from 1648 children (51.9% female, 62.8% World Health Organization (WHO) stage 3/4) were analyzed. Median (interquartile range) age was 6.8 (3.7-9.6) years, CD4% was 9 (3-16)%, and plasma HIV-RNA was 5.2 (4.7-5.6) log10 copies/ml at HAART initiation in those with available testing. The most common regimens were stavudine/lamivudine/nevirapine (42%) and zidovudine/lamivudine/nevirapine (25%). Severe anemia was identified in 47 (2.9%) children after a median time of 6 months after HAART initiation, with an incidence rate of 5.4 per 100 child-years. Mild anemia or moderate anemia at baseline (p = 0.024 and p = 0.005, respectively), previous or current use of zidovudine (p < 0.0001 and p = 0.013, respectively), and male sex (p = 0.008) were associated with severe anemia. Higher weight-for-age z-score (p = 0.004) was protective.
  
  
  CONCLUSIONS
  The incidence of severe anemia in Asian HIV-infected children after HAART initiation was low and mainly occurred during the first few months after HAART initiation. Mild to moderate anemia at baseline and using zidovudine were independent risk factors for the development of severe anemia.
authors.affiliation: HIV-NAT, the Thai Red Cross AIDS Research Center, 104 Ratchadamri Road, Pathumwan, Bangkok, Thailand 10330; Kirby Institute for Infection and Immunity in Society, UNSW, Sydney, Australia. Electronic address: torsak.b@hivnat.org.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Kwai-Cheng
authors.initials: KC
authors.lastname: Chan
authors.forename: Reshmie
authors.initials: R
authors.lastname: Ramautarsing
authors.forename: Bui Vu
authors.initials: BV
authors.lastname: Huy
authors.forename: Ning
authors.initials: N
authors.lastname: Han
authors.forename: Revathy
authors.initials: R
authors.lastname: Nallusamy
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Vonthanak
authors.initials: V
authors.lastname: Saphonn
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Nik Khairulddin Nik
authors.initials: NK
authors.lastname: Yusoff
authors.forename: Kamarul
authors.initials: K
authors.lastname: Razali
authors.forename: Siew Moy
authors.initials: SM
authors.lastname: Fong
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
mesh_terms: D000740:Anemia / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001210:Asia, Southeastern / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine
keywords: Anemia; Antiretroviral therapy; Asia; Pediatric HIV