title: Anaemia in pregnancy is associated with advanced HIV disease.
abstract: BACKGROUND
  Anaemia is a common clinical finding in HIV infected women and has been associated with advanced disease. The use of antiretroviral drugs such as Zidovudine (ZDV) either for prevention of mother to child transmission (MTCT) of HIV or used in combination with other antiretrovirals have been implicated in the development or increased severity of anaemia. We report the prevalence, type, severity and incidence of anaemia in a cohort of HIV infected women who initiated antiretroviral prophylaxis or treatment during pregnancy.
  
  
  METHODS
  This is a retrospective cohort data analysis of 408 HIV infected pregnant women who participated in a breastfeeding intervention study (HPTN 046 Study, ClinicalTrials.gov NCT 00074412) in South Africa. Women initiated zidovudine prophylaxis for PMTCT or triple antiretroviral treatment in pregnancy according to the standard of care. Laboratory and clinical data in pregnancy, <72 hours and 2 weeks postdelivery were extracted from the main database and analysed.
  
  
  RESULTS
  The mean Hb concentration was 10.6 g/dL at baseline and 262/408 (64.2%) women were diagnosed with anaemia (Hb<11 g/dL) in pregnancy, 48/146 (32.9%) subsequently developed anaemia intrapartum or postpartum and 89/310 (28.7%) of all cases of anaemia remained unresolved by 2 weeks postdelivery. In a univariate analysis, CD4 count and gravidity were significant risk factors for anaemia in pregnancy, RR 1.41; 1.23-1.61 (p<0.001) and 1.10; 1.01-1.18 (p = 0.02) respectively. After adjusting for antiretroviral regimen, age and gravidity in a multivariable analysis, only the CD4 count remains a significant risk factor for anaemia in pregnancy and postdelivery.
  
  
  CONCLUSIONS
  In conclusion, anaemia was most common among women in the advanced stage of HIV infection (CD4<200 cells/mm3). There was no evidence of an association between ZDV or triple ARVs and anaemia.
authors.affiliation: Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Nandlal
authors.affiliation: Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa; Center for the AIDS Programme of Research in South Africa-CAPRISA, Durban, South Africa.
authors.forename: Dhayendre
authors.initials: D
authors.lastname: Moodley
authors.affiliation: Center for the AIDS Programme of Research in South Africa-CAPRISA, Durban, South Africa.
authors.forename: Anneke
authors.initials: A
authors.lastname: Grobler
authors.affiliation: Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Jayanthilall
authors.initials: J
authors.lastname: Bagratee
authors.affiliation: Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Niren R
authors.initials: NR
authors.lastname: Maharaj
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Richardson
mesh_terms: D000740:Anemia / Q000150:complications* / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D015999:Multivariate Analysis; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine