title: Anaemia in HIV-infected pregnant women receiving triple antiretroviral combination therapy for prevention of mother-to-child transmission: a secondary analysis of the Kisumu breastfeeding study (KiBS).
abstract: OBJECTIVE
  The prevalence of anaemia during pregnancy is estimated to be 35-75% in sub-Saharan Africa and is associated with an increased risk of maternal mortality. We evaluated the frequency and factors associated with anaemia in HIV-infected women undergoing antiretroviral (ARV) therapy for prevention of mother-to-child transmission (PMTCT) enrolled in The Kisumu Breastfeeding Study 2003-2009.
  
  
  METHODS
  Maternal haematological parameters were monitored from 32 to 34 weeks of gestation to 2 years post-delivery among 522 enrolled women. Clinical and laboratory assessments for causes of anaemia were performed, and appropriate management was initiated. Anaemia was graded using the National Institutes of Health Division of AIDS 1994 Adult Toxicity Tables. Data were analysed using SAS software, v 9.2. The Wilcoxon two-sample rank test was used to compare groups. A logistic regression model was fitted to describe the trend in anaemia over time.
  
  
  RESULTS
  At enrolment, the prevalence of any grade anaemia (Hb < 9.4 g/dl) was 61.8%, but fell during ARV therapy, reaching a nadir (7.4%) by 6 months post-partum. A total of 41 women (8%) developed severe anaemia (Hb < 7 g/dl) during follow-up; 2 (4.9%) were hospitalised for blood transfusion, whereas 3 (7.3%) were transfused while hospitalised (for delivery). The greatest proportion of severe anaemia events occurred around delivery (48.8%; n = 20). Anaemia (Hb ≥ 7 and < 9.4 g/dl) at enrolment was associated with severe anaemia at delivery (OR 5.87; 95% CI: 4.48, 7.68, P < 0.01). Few cases of severe anaemia coincided with clinical malaria (24.4%; n = 10) and helminth (7.3%; n = 3) infections.
  
  
  CONCLUSIONS
  Resolution of anaemia among most participants during study follow-up was likely related to receipt of ARV therapy. Efforts should be geared towards addressing common causes of anaemia in HIV-infected pregnant women, prioritising initiation of ARV therapy and management of peripartum blood loss.
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Collins
authors.initials: C
authors.lastname: Odhiambo
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.|Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Clement
authors.initials: C
authors.lastname: Zeh
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Frank
authors.initials: F
authors.lastname: Angira
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Valarie
authors.initials: V
authors.lastname: Opollo
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Brenda
authors.initials: B
authors.lastname: Akinyi
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Masaba
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: John M
authors.initials: JM
authors.lastname: Williamson
authors.affiliation: Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya.
authors.forename: Juliana
authors.initials: J
authors.lastname: Otieno
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.|Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Shirley Lee
authors.initials: SL
authors.lastname: Lecher
authors.affiliation: Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015995:Prevalence; D019562:Viral Load
chemical_list: D006454:Hemoglobins
keywords: Anemia; HIV; VIH; anaemia; antiretroviral therapy; anémie; prevención de la transmisión madre-hijo; prevention of mother-to-child transmission; prévention de la transmission mère-enfant; terapia antiretroviral; thérapie antirétrovirale