title: Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa.
abstract: Background.  Morbidity and mortality remain high among hospitalized patients infected with human immunodeficiency virus (HIV) in sub-Saharan Africa despite widespread availability of antiretroviral therapy. Severe anemia is likely one important driver, and some evidence suggests that blood transfusions may accelerate HIV progression and paradoxically increase short-term mortality. We investigated the relationship between anemia, blood transfusions, and mortality in a South African district hospital. Methods.  Unselected consecutive HIV-infected adults requiring acute medical admission to a Cape Town township district hospital were recruited. Admission hemoglobin concentrations were used to classify anemia severity according to World Health Organization/AIDS Clinical Trials Group criteria. Vital status was determined at 90 days, and Cox regression analyses were used to determine independent predictors of mortality. Results.  Of 585 HIV-infected patients enrolled, 578 (98.8%) were included in the analysis. Anemia was detected in 84.8% of patients and was severe (hemoglobin, 6.5-7.9 g/dL) or life-threatening (hemoglobin, <6.5 g/dL) in 17.3% and 13.3%, respectively. Within 90 days of the date of admission, 13.5% (n = 78) patients received at least 1 blood transfusion with red cell concentrate and 77 (13.3%) patients died. In univariable analysis, baseline hemoglobin and receipt of blood transfusion were associated with increased mortality risk. However, in multivariable analysis, neither hemoglobin nor receipt of a blood transfusion were independently associated with greater mortality risk. Acquired immune deficiency syndrome-defining illnesses other than tuberculosis and impaired renal function independently predicted mortality. Conclusions.  Newly admitted HIV-infected adults had a high prevalence of severe or life-threatening anemia and blood transfusions were frequently required. However, after adjustment for confounders, blood transfusions did not confer an increased mortality risk.
authors.affiliation: Department of Medicine, University of California San Francisco School of Medicine; Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, The Netherlands; Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Kerkhoff
authors.affiliation: Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; Department of Medicine, Faculty of Health Sciences, University of Cape Town.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Schutz
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town; Khayelitsha District Hospital, Cape Town.
authors.forename: Rosie
authors.initials: R
authors.lastname: Burton
authors.affiliation: Faculty of Health Sciences, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town; Department of Health, Provincial Government of the Western Cape, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.affiliation: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, The Netherlands; KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Cobelens
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town; Department of Medicine, Imperial College, London, United Kingdom.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
keywords: AIDS; Africa; HIV; anemia; blood transfusion; hospitalized; mortality