Incidence and predictors of recovery from anaemia within an HIV-infected South African Cohort, 2004-2010.
BACKGROUND
Anaemia is one of the most frequent haematological complications in HIV-infected persons. Understandingfactors associated with recovery from anaemia during ART is vital in improving clinical outcomes since anaemia is a strong predictor of mortality.


METHODS
Cohort study of 12,441 HIV-infected adults initiating ART between 2004-2010 in Johannesburg, South Africa. A further 2,489 patients with prevalent anaemia at ART initiation were examined to determine the incidence and predictors of recovery from anaemia. Cox proportional hazards models were fitted to investigate predictors of recovery from anaemia.


RESULTS
Of the 2,489 patients with prevalent anaemia, most patients (n=2,225, 89.4%) recovered from anaemia. Median time to anaemia recoverywas 3.9 months (IQR: 3.22-6.20) and incidence rate was 180 per 100person years (95% CI: 172-187). In univariateanalysis, sex, CD4 count, BMI, WHO stage, employment status, smoking status and presence of tuberculosis at initiation ofART were significant predictors of recovery from anaemia. However in multivariateanalysis, predictors of recovery from anaemia were: male sex-HR: 1.43 (95% CI: 1.29-1.59) p<0.001, advanced WHO stage III/IV-HR: 1.17 (95% CI: 1.07-1.29) p=0.001). There was no significant association with CD4 count in multivariate analysis.


CONCLUSIONS
A large proportion of HIV infected patients with anaemia at baseline recover early during the course of ART. Females and those with less advanced WHO stage seem to be at higher risk of poor recovery from anaemia. Understanding the predictors for poor recovery from anaemia would allow closer follow-up and more targeted interventions thus reducing excess anaemia and mortality burden.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Zibusiso
Z
Ndlovu
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Tobias
T
Chirwa
Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
Simbarashe
S
Takuva
D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors
D019380:Anti-HIV Agents
AIDS; Haemoglobin; Themba Lethu clinical cohort; antiretroviral therapy; human immunodeficiency virus