title: Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania.
abstract: Anemia is often a comorbidity of human immunodeficiency virus (HIV) infection. Many cross-sectional studies have been conducted on anemia and HIV, but few, if any, have addressed incidence of anemia prospectively. A longitudinal analysis was conducted in 48,068 nonpregnant HIV-infected adults in Dar es Salaam, Tanzania, seen at Management and Development for Health-U.S. President's Emergency Plan for AIDS Relief HIV care and treatment programs between 2004 and 2011. Almost 56% (N = 27,184) of study participants had anemia (hemoglobin < 11 g/dL) at the time of enrollment at the clinic. Female gender, low body mass index (BMI), low CD4 T-cell count, high levels of liver enzyme alanine aminotransferase, antiretroviral treatment (ART) regimens, and concurrent tuberculosis treatment were all independently significantly associated with an increased risk of anemia. Low BMI and low CD4 T-cell count were independently significantly associated with an increased risk for iron deficiency anemia (IDA). Higher BMI status and ART use were associated with recovery from anemia. Anemia, including IDA, is a comorbidity that is associated with other adverse consequences (e.g., low BMI and CD4 T-cell count) among individuals with HIV infection, including those on ART. Interventions to prevent anemia and its complications need to be examined in the context of future studies.
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania paul.petraro@post.harvard.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Petraro
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Abel
authors.initials: A
authors.lastname: Makubi
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Helen
authors.initials: H
authors.lastname: Siril
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.affiliation: Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents