title: Development of Severe Anemia and Changes in Hemoglobin in a Cohort of HIV-Infected Ugandan Adults Receiving Zidovudine-, Stavudine-, and Tenofovir-Containing Antiretroviral Regimens.
abstract: BACKGROUND
  Anemia is a common problem in HIV in sub-Saharan Africa. We describe the contribution of antiretroviral therapy (ART) regimen to the incidence of anemia and changes in hemoglobin (Hb) in HIV-infected patients in Uganda.
  
  
  METHODS
  This study was nested in a prevention of cryptococcal disease trial (CRYPTOPRO; ISCRTN7648152). Patients received 3 different backbones of nucleoside reverse transcriptase inhibitor in a nonrandomized manner.
  
  
  RESULTS
  Of the 852 patients (161 on zidovudine [ZDV], 628 on stavudine [d4T], and 63 on tenofovir [TDF]; all received lamuvidine), the risk of developing grade 4 anemia was higher (adjusted hazard ratio 2.7) for those receiving ZDV than those receiving d4T. Those receivingd4T had a higher average increase in Hb than those receiving ZDV (P = .024) or TDF (P = .014).
  
  
  CONCLUSIONS
  In this observational study, ZDV was associated with severe anemia compared to d4T or TDF; those receiving ZDV and TDF had smaller increases in Hb after ART initiation. We encourage publication of data on cohorts using TDF from Africa.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda Liverpool School of Tropical Medicine, Liverpool, United Kingdom Infectious Diseases Insitute, Kampala, Uganda rratanshi@idi.co.ug.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Parkes-Ratanshi
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Katende
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda Liverpool School of Tropical Medicine, Liverpool, United Kingdom Epidemiology and Genetics Unit, University of York, York, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Wakeham
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda London School of Tropical Medicine and Hygiene, London, United Kingdom.
authors.forename: Grosskurth
authors.initials: G
authors.lastname: Heiner
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda.
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom Infectious Diseases Insitute, Kampala, Uganda.
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
mesh_terms: D000328:Adult; D000740:Anemia / Q000139:chemically induced* / Q000821:virology; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects; D000068698:Tenofovir / Q000008:administration & dosage / Q000009:adverse effects; D014454:Uganda; D015215:Zidovudine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D000068698:Tenofovir; D018119:Stavudine
keywords: ART; Africa; Uganda; anemia; hemoglobin; tenofovir; zidovudine