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Opie J, Verburgh E, Bailly J, Mayne E, Louw V. Hematological Complications of Human Immunodeficiency Virus (HIV) Infection: An Update From an HIV-Endemic Setting. Open Forum Infect Dis 2024; 11:ofae162. [PMID: 38601746 PMCID: PMC11004791 DOI: 10.1093/ofid/ofae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/17/2024] [Indexed: 04/12/2024] Open
Abstract
Medical professionals, particularly in regions with a high burden of human immunodeficiency virus (HIV), should be alert to the hematological complications of HIV, which may include cytopenias, malignancy, and coagulation disturbances. Patients may present with these conditions as the first manifestation of HIV infection. Hematological abnormalities are often multifactorial with opportunistic infections, drugs, malignancy, and HIV infection itself contributing to the clinical presentation, and the diagnosis should consider all these factors. Life-threatening hematological complications requiring urgent diagnosis and management include thrombotic thrombocytopenic purpura, superior mediastinal syndrome, spinal cord compression, and tumor lysis syndrome due to aggressive lymphoma. Antiretroviral therapy is the therapeutic backbone, including for patients with advanced HIV, in addition to specific therapy for the complication. This article reviews the impact of HIV on the hematological system and provides a clinical and diagnostic approach, including the role of a bone marrow biopsy, focusing on perspectives from sub-Saharan Africa.
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Affiliation(s)
- Jessica Opie
- Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Estelle Verburgh
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Jenique Bailly
- Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Elizabeth Mayne
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Vernon Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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Wei L, Zhao Y, Gan X, Zhao D, Wu Y, Dou Z, Ma Y. The burden of anemia among Chinese HIV-infected patients following the initiation of antiretroviral therapy in the treat-all era: a nationwide cohort study. BMC Infect Dis 2023; 23:704. [PMID: 37858044 PMCID: PMC10588238 DOI: 10.1186/s12879-023-08675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era. METHODS All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death. RESULTS Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80-3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67-6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55-2.76; moderate anemia: aHR = 4.60; 95% CI:4.40-4.81; severe anemia: aHR = 6.41; 95% CI:5.94-6.91). CONCLUSIONS In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.
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Affiliation(s)
- Lai Wei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yan Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China.
| | - Xiumin Gan
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Decai Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yasong Wu
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Zhihui Dou
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Ye Ma
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
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Gezae KE, Hagos K, Gebreslassie AA. Severity and Determinants of Anemia in TB/HIV Coinfected Adults at Mekelle, Ethiopia: Hospital Based Retrospective Study. J Trop Med 2023; 2023:5555030. [PMID: 37234694 PMCID: PMC10208761 DOI: 10.1155/2023/5555030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Background Anemia has up to 87% prevalence in high tuberculosis (TB) and human immunodeficiency virus (HIV) burden settings of the sub-Saharan Africa (SSA) including Ethiopia. It increases lost to follow-up (LTFU) rate, reduces quality of life, and shortens the survival of TB/HIV coinfected patients. However, there is limited information on severity level and determinants of anemia in TB/HIV coinfected adults in the study setting in particular. Therefore, this study is aimed to assess severity level and determinants of TB/HIV-associated anemia. Methods A hospital based retrospective study was conducted among 305 TB/HIV coinfected adults who enrolled for antiretroviral therapy (ART) from January, 2009 to December, 2016 in two public hospital of Mekelle, Ethiopia, by reviewing ART register. A multiple logit model was fitted to identify the baseline determinants of anemia using 95% confidence level or 5% level of significance for adjusted odds ratio (AOR). Results In the current study, the cumulative baseline prevalence of anemia was 59.0% (95% CI: 53.3%-64.6%). Considering severity level, the prevalence was 6.2%, 28.2%, and 24.6% for severe, moderate, and mild anemia, respectively. Being female (AOR = 0.380; 95% CI: 0.226-0.640), body mass index (AOR = 0.913; 95% CI: 0.836-0.998) reduces the odds of developing anemia whereas baseline ambulatory functional status (AOR = 2.139; 95% CI: 1.189-3.846), bedridden functional status (AOR = 2.208; 95% CI: 1.002-4.863), HIV clinical stage III (AOR = 2.565; 95% CI: 1.030-6.384), and HIV clinical stage IV (AOR = 2.590; 95% CI: 1.006-6.669) increased the odds of developing anemia for TB/HIV coinfected adults. Conclusions In the current study, significant TB/HIV-associated severe anemia was assessed which accounted for nearly one-ninth of all anemia cases while nearly half were moderate anemia. Therefore, curious attention has to be given for the management of TB/HIV-associated severe anemia in particular and anemia in general to reducing anemia associated bad outcomes most importantly death.
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Affiliation(s)
- Kebede Embaye Gezae
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kiflom Hagos
- Department of Medical Microbiology and Immunology, Biomedical Division, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Assefa Ayalew Gebreslassie
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Ibraheem Abioye A, Sudfeld CR, Hughes MD, Aboud S, Muhihi A, Ulenga N, Nagu TJ, Wang M, Mugusi F, Fawzi WW. Iron status among HIV-infected adults during the first year of antiretroviral therapy in Tanzania. HIV Med 2023; 24:398-410. [PMID: 36075691 PMCID: PMC9992443 DOI: 10.1111/hiv.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The influence of inflammation on iron status among people living with HIV (PLWHIV) has not been well explored. We evaluated the trajectory of iron status among PLWHIV during the first year of highly active antiretroviral therapy (HAART), compared alternative approaches for inflammation correction, and assessed the associations of iron status with HIV-1 viral load and anthropometric outcomes. METHODS We conducted a secondary analysis of data from a randomized trial among 400 adults initiating HAART in Tanzania. Ferritin and C-reactive protein (CRP) were measured at baseline, 1, 6 or 12 months. Ferritin was considered in four ways: unadjusted, and adjusted for inflammation using higher cut-off (HC), Thurnham-corrected (TC) and regression-corrected (RC) approaches. For unadjusted, TC and RC ferritin, iron deficiency (ID) was defined using ferritin < 15 μg/L and elevated iron status was defined using ferritin > 150 μg/L among females and > 200 μg/L among males. For HC ferritin, elevated iron status was defined based on serum ferritin > 500 μg/L, while ID was defined using ferritin < 70 μg/L in the presence of inflammation and < 15 μg/L in the absence of inflammation. Regression models evaluated the trajectory of ferritin concentration across categories of baseline characteristics, and assessed the association of iron status with viral and anthropometric outcomes. RESULTS The prevalence of iron deficiency at HAART initiation was 9% for unadjusted, 17% for HC, 12% for TC and 22% for RC ferritin. The prevalence of elevated iron status was 42% for unadjusted, 18% for HC, 31% for TC, and 15% for RC ferritin. The prevalence of iron deficiency for all three methods increased during the first year of HAART, while the prevalence of elevated iron status decreased. Baseline elevated iron status defined using HC ferritin was associated with a greater risk of HIV-1 viral load > 1000 copies/mL [relative risk (RR) = 4.29, 95% CI: 1.38-13.3] and incidence of being underweight [body mass index (BMI) < 18.5 kg/m2 , hazard ratio (HR) = 3.65, 95% confidence interval (CI): 1.38-9.67]. Neither baseline-elevated iron status defined using TC or RC ferritin nor baseline iron deficiency defined using any of the three methods was associated with HIV-1 viral load or anthropometric outcomes. CONCLUSIONS Whether and how inflammation correction is done influences findings of studies of iron status among PLWHIV.
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Affiliation(s)
- Ajibola Ibraheem Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christopher R. Sudfeld
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael D. Hughes
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alfa Muhihi
- Management and Development for Health (MDH), Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health (MDH), Dar es Salaam, Tanzania
| | - Tumaini J. Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Tilahun M, Gedefie A, Ebrahim E, Seid A, Ali A, Shibabaw A, Belete MA, Fiseha M, Tesfaye M, Ebrahim H, Abera A. Immuno-Haematological Abnormalities of HIV-Infected Patients Before and After Initiation of Highly Active Antiretroviral Therapy in the Antiretroviral Therapy Clinics of Six Health Facilities at Dessie Town, Northeast Ethiopia. J Blood Med 2022; 13:243-253. [PMID: 35592587 PMCID: PMC9112337 DOI: 10.2147/jbm.s364700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background In people living with the human immunodeficiency virus, haematological abnormalities have been linked to an increased risk of disease progression and mortality. Hematological parameters may have a positive or negative impact on antiretroviral therapy. The aim of this study was to assess the immuno-haematological abnormalities of HIV-infected patients before and after the initiation of highly active antiretroviral therapy in the antiretroviral therapy clinics of six health facilities in Dessie, Northeast Ethiopia. Methods A facility-based cross-sectional study was conducted from April to May 30, 2021, at the antiretroviral therapy clinics of six health facilities in Dessie Town. A total of 378 HIV-infected patients taking highly active antiretroviral treatment for at least 6 months by using a consecutive sampling technique were included. A well-organized questionnaire was used to collect socio-demographic and clinical information. Immune-haematological parameters were tested using a Mindray BS-300 hematology analyzer and a BD FACS count CD4 analyzer. Statistical analysis was performed using SPSS version 25 statistical software. Statistical significance was defined as a P-value of 0.05 with a 95% confidence interval. Results Leukopenia was found in 26.7% and 16.5%, neutropenia in 16.5% and 9.4%, lymphopenia in 20% and 3.1%, and thrombocytopenia in 25.9% and 7.1% of HIV patients before and after HAART initiation, respectively. There was a significant difference in total white blood cell, absolute neutrophil, red blood cell, hemoglobin value, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet and CD4+ T cell counts in HIV patients before and after the initiation of HAART with P < 0.05. Conclusion and Recommendation Anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia were the most common haematological abnormalities found in this study before and after HAART initiation. The prevalence of thrombocytopenia, immunosuppression, and viral load was reduced considerably after starting HAART.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Mihret Tilahun, Department of Medical Laboratory Science College of Medicine and Health Sciences, Wollo University, Po.Box: 1145, Dessie, Ethiopia, Tel +251-920988307, Fax +251 333115250, Email
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Abdurrahman Ali
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melkam Tesfaye
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Admasu Abera
- Department of Medical Laboratory Science, Debre Birhan health Science college, North Showa, Ethiopia
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Cao G, Wang Y, Wu Y, Jing W, Liu J, Liu M. Prevalence of anemia among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 44:101283. [PMID: 35128369 PMCID: PMC8803600 DOI: 10.1016/j.eclinm.2022.101283] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Anemia is the most frequent hematologic abnormality among people living with human immunodeficiency virus (HIV) (PLWHIV) and is associated with HIV disease progression and higher risk of mortality of the patients. However, there is a wide variation of the prevalence of anemia among PLWHIV in different clinical settings. We aimed to obtain more precise estimates of prevalence of anemia and severity of anemia among PLWHIV, which may be important for patients, caregivers, researchers and health policy-makers. METHODS We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for original articles reporting the prevalence of anemia defined using age and sex-specific hemoglobin levels according to World Health Organization criteria among PLWHIV from inception to August 31, 2021. We used DerSimonian-Laird random-effects meta-analyses to obtain pooled prevalence and 95% confidence intervals (CIs) of anemia and severity of anemia among PLWHIV. A univariable meta-regression has been conducted to assess the association between anemia prevalence and study characteristics, including study design, median year of sampling, geographical region, World Bank Income level, and proportion of antiretroviral therapy (ART). FINDINGS We included 63 observational studies covering 110,113 PLWHIV. The pooled prevalence of anemia was 39.7% (95% CI: 31.4%-48.0%) for children living with HIV aged <15 years, 46.6% (95% CI: 41.9%-51.4%) for adults (men and non-pregnant women) living with HIV aged ≥15 years, and 48.6% (95% CI: 41.6%-55.6%) for pregnant women living with HIV. Among adults living with HIV, the pooled prevalence of severity of anemia was 21.6% (95% CI: 19.9%-23.3%), 22.6% (95% CI: 14.8%-30.4%), and 6.2% (95% CI: 4.4%-8.1%) for mild, moderate and severe anemia, respectively. Compared with East Africa, anemia prevalence among adults living with HIV was higher in Southern Africa (p = 0.033). INTERPRETATION Anemia is prevalent among PLWHIV. Thus, policies, strategies, and programs should be considered to identify the predictors of anemia among PLWHIV to reduce the burden of anemia among patients in the ART era.
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Kitilya B, PrayGod G, Peck R, Changalucha J, Jeremiah K, Kavishe BB, Friis H, Filteau S, Faurholt-Jepsen D, Krogh-Madsen R, Brage S, Olsen MF. Levels and correlates of physical activity and capacity among HIV-infected compared to HIV-uninfected individuals. PLoS One 2022; 17:e0262298. [PMID: 35061774 PMCID: PMC8782412 DOI: 10.1371/journal.pone.0262298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/21/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION In the HIV-infected individuals, physical activity improves physical strength, quality of life and reduces the risk of developing non-communicable diseases. In Sub-Saharan Africa, HIV-infected patients report being less active compared to HIV-uninfected individuals. We assessed the levels and correlates of objectively measured physical activity and capacity among HIV-infected antiretroviral therapy (ART)-naive individuals compared to HIV-uninfected individuals in Mwanza, Tanzania. METHOD We conducted a cross-sectional study among newly diagnosed HIV-infected ART-naive individuals and HIV-uninfected individuals frequency-matched for age and sex. Socio-demographic data, anthropometrics, CD4 counts, haemoglobin level, and C-reactive protein (CRP) were collected. Physical activity energy expenditure (PAEE) was assessed as measure of physical activity whereas sleeping heart rate (SHR) and grip strength were assessed as measures of physical capacity. Multivariable linear regression was used to assess the correlates associated with physical activity and capacity. RESULTS A total of 272 HIV-infected and 119 HIV-uninfected individuals, mean age 39 years and 60% women participated in the study. Compared to HIV-uninfected individuals, HIV-infected had poorer physical activity and capacity: lower PAEE (-7.3 kj/kg/day, 95% CI: -11.2, -3.3), elevated SHR (7.7 beats/min, 95%CI: 10.1, 5.3) and reduced grip strength (-4.7 kg, 95%CI: -6.8, -2.8). In HIV-infected individuals, low body mass index, moderate-severe anaemia, low CD4 counts and high CRP were associated with lower physical activity and capacity. In HIV-uninfected individuals, abdominal obesity and moderate anaemia were associated with lower physical activity and capacity. CONCLUSION HIV-infected participants had lower levels of physical activity and capacity than HIV-uninfected participants. Correlates of physical activity and capacity differed by HIV status. Management of HIV and related conditions needs to be provided effectively in health care facilities. Interventions promoting physical activity in these populations will be of importance to improve their health and reduce the risk of non-communicable diseases.
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Affiliation(s)
- Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
- * E-mail:
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Robert Peck
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
- Weill Bugando School of Medicine, Mwanza, Tanzania
- Weill Cornell Medicine, New York, New York, United States of America
| | - John Changalucha
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Ghislain MR, Mushebenge GAA, Magula N. Cause of hospitalization and death in the antiretroviral era in Sub-Saharan Africa published 2008-2018: A systematic review. Medicine (Baltimore) 2021; 100:e27342. [PMID: 34713822 PMCID: PMC8556022 DOI: 10.1097/md.0000000000027342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Worldwide despite the availability of antiretroviral therapy, human immunodeficiency virus/acquired immunodeficiency syndrome still causes morbidity and mortality among patients. In Sub-Saharan Africa, human immunodeficiency virus/acquired immunodeficiency syndrome remains a major public health concern. The aim of this study was to identify the causes of morbidity and mortality in the modern antiretroviral therapy era in Sub-Saharan Africa. METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched relevant studies from 3 databases which are Google Scholar, PubMed, and CINAHL. Two review authors independently screened titles, abstracts, and full-text articles in duplicate, extracted data, and assessed bias. Discrepancies were resolved by discussion or arbitration of a third review author. R software version 3.6.2 was used to analyze the data. Maximum values were used in order to show which disease was mostly spread out by looking at the highest prevalence reported. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS A total of 409 articles were obtained from the database search, finally 12 articles met the inclusion criteria and were eligible for data extraction. Among them, 3 were conducted in Nigeria, 2 were conducted in Uganda, 3 were conducted in South Africa, 1 in Gabon, 1 in Ethiopia, 1 in Ghana, and 1 in Burkina Faso. In most of the included studies, tuberculosis was the leading cause of hospitalization which accounted for between 18% and 40.7% and it was also the leading cause of death and accounted for between 16% and 44.3%, except in 1 which reported anemia as the leading cause of hospitalization and in 2 which reported wasting syndrome and meningitis respectively as the leading causes of death. Opportunistic malignancies accounted between for 1.8% to 5% of hospitalization and 1.2% to 9.8% of deaths. CONCLUSIONS Tuberculosis is the commonest cause of hospitalization and death in Sub-Saharan Africa, but it is always followed by other infectious disease and other non-AIDS related causes.
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Affiliation(s)
- Manimani Riziki Ghislain
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | | | - Nombulelo Magula
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
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Wang J, Zheng Y, Chen Y, Hu X, Peng M, Fang Y, Shen B, Lu G. Laboratory indicators in COVID-19 and other pneumonias: Analysis for differential diagnosis and comparison of dynamic changes during 400-day follow-up. Comput Struct Biotechnol J 2021; 19:2497-2507. [PMID: 33936563 PMCID: PMC8076761 DOI: 10.1016/j.csbj.2021.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background COVID-19 is spreading rapidly all over the world, the patients' symptoms can be easily confused with other pneumonia types. Therefore, it is valuable to seek a laboratory differential diagnostic protocol of COVID-19 and other pneumonia types on admission, and to compare the dynamic changes in laboratory indicators during follow-up. Methods A total of 143 COVID-19, 143 bacterial pneumonia and 145 conventional viral pneumonia patients were included. The model group consisted of 140 COVID-19, 80 bacterial pneumonia and 60 conventional viral pneumonia patients, who were age and sex matched. We established a differential diagnostic model based on the laboratory results of the model group on admission via a nomogram, which was validated in an external validation group. We also compared the 400-day dynamic changes of the laboratory indicators among groups. Results LASSO regression and multivariate logistic regression showed that eosinophils (Eos), total protein (TP), prealbumin (PA), potassium (K), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDLC) could differentiate COVID-19 from other pneumonia types. The C-index of the nomogram model was 0.922. Applying the nomogram to the external validation group showed an area under the curve (AUC) of 0.902. The 400-day change trends of the laboratory indexes varied among subgroups divided by sex, age, oxygenation index (OI), and pathogen. Conclusion The laboratory model was highly accurate at providing a new method to identify COVID-19 in pneumonia patients. The 400-day dynamic changes in laboratory indicators revealed that the recovery time of COVID-19 patients was not longer than that of other pneumonia types.
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Affiliation(s)
- Jing Wang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Yufen Zheng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Yijun Chen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Xingzhong Hu
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Dingli Clinical School of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Minfei Peng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Yicheng Fang
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Bo Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
| | - Guoguang Lu
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China
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10
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Harding BN, Whitney BM, Nance RM, Ruderman SA, Crane HM, Burkholder G, Moore RD, Mathews WC, Eron JJ, Hunt PW, Volberding P, Rodriguez B, Mayer KH, Saag MS, Kitahata MM, Heckbert SR, Delaney JAC. Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study. BMC Infect Dis 2020; 20:238. [PMID: 32197585 PMCID: PMC7085166 DOI: 10.1186/s12879-020-04958-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking. Methods Within a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010–3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between time-updated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site. Results This retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3–7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR. Conclusion Because anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.
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Affiliation(s)
- B N Harding
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA.
| | - B M Whitney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - R M Nance
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S A Ruderman
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - H M Crane
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - G Burkholder
- University of Alabama Birmingham, Birmingham, USA
| | - R D Moore
- Johns Hopkins University, Baltimore, USA
| | - W C Mathews
- University of California San Diego, San Diego, USA
| | - J J Eron
- University of North Carolina, Chapel Hill, USA
| | - P W Hunt
- University of California San Francisco, San Francisco, USA
| | - P Volberding
- University of California San Francisco, San Francisco, USA
| | - B Rodriguez
- Case Western Reserve University, Cleveland, USA
| | - K H Mayer
- Fenway Health Institute, Boston, USA
| | - M S Saag
- University of Alabama Birmingham, Birmingham, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S R Heckbert
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
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11
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Harding BN, Whitney BM, Nance RM, Crane HM, Burkholder G, Moore RD, Mathews WC, Eron JJ, Hunt PW, Volberding P, Rodriguez B, Mayer K, Saag MS, Kitahata MM, Heckbert SR, Delaney JAC. Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study. BMJ Open 2020; 10:e031487. [PMID: 32198297 PMCID: PMC7103836 DOI: 10.1136/bmjopen-2019-031487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemoglobin change with core ART classes in the current ART era. DESIGN Retrospective cohort study. SETTING USA-based prospective clinical cohort of PLWH aged 18 and above receiving care at eight sites between January 2010 and March 2018. PARTICIPANTS 16 505 PLWH were included in this study. MAIN OUTCOME MEASURES Anaemia risk and haemoglobin change were estimated among PLWH for person-time on a protease inhibitor (PI) or an integrase strand transfer inhibitor (INSTI)-based regimen, relative to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based reference. We also examined PLWH on regimens containing multiple core classes. Cox proportional hazards regression analyses were conducted to measure the associations between time-updated ART classes and incident anaemia or severe anaemia. Linear mixed effects models were used to examine the relationships between ART classes and haemoglobin change. RESULTS During a median of 4.9 years of follow-up, 1040 developed anaemia and 488 developed severe anaemia. Compared with NNRTI use, INSTI-based regimens were associated with an increased risk of anaemia (adjusted HR (aHR) 1.26, 95% CI 1.00 to 1.58) and severe anaemia (aHR 1.51, 95% CI 1.07 to 2.11) and a decrease in haemoglobin level. Time on multiple core classes was also associated with increased anaemia risk (aHR 1.39, 95% CI 1.13 to 1.70), while no associations were found for PI use. CONCLUSION These findings suggest INSTI use may increase the risk of anaemia. If confirmed, screening for anaemia development in users of INSTIs may be beneficial. Further research into the underlying mechanisms is warranted.
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Affiliation(s)
- Barbara N Harding
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Bridget M Whitney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Robin M Nance
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Heidi M Crane
- Medicine, University of Washington, Seattle, Washington, USA
| | | | - Richard D Moore
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter W Hunt
- University of California San Francisco, San Francisco, California, USA
| | - Paul Volberding
- Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Kenneth Mayer
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mari M Kitahata
- Medicine, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Joseph A C Delaney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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12
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Barzegari S, Afshari M, Movahednia M, Moosazadeh M. Prevalence of anemia among patients with tuberculosis: A systematic review and meta-analysis. Indian J Tuberc 2019; 66:299-307. [PMID: 31151500 DOI: 10.1016/j.ijtb.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/17/2019] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Anemia is one of the most common hematologic problems occurs among patients with tuberculosis (TB). Many studies have been carried out estimating the prevalence of anemia among TB patients in different countries reported various results. This study aims to estimate the combined estimate of the anemia prevalence among these patients using systematic review and meta-analysis. METHODS Required primary studies were provided after a comprehensive and systematic search in PubMed, Scopus, Science direct, Web of Science and also Google scholar search engine. These studies were then quality assessed using Newcastle-Ottawa Scale checklist. Random effects model was applied for combining the point prevalence with 95% confidence intervals. RESULTS Of 41 papers entered into the meta-analysis, prevalence (95% confidence interval) of anemia among all TB patients as well as men and women were 61.53% (53.44-69.63), 66.95% (51.75-82.14) and 72.67% (60.79-84.54) respectively. Prevalence (95% confidence intervals) of mild, moderate and severe anemia were 35.67% (27.59-43.46), 31.19% (25.15-37.24) and 11.61% (7.88-15.34) respectively. In addition, prevalence (95% confidence intervals) of chronic disease anemia and iron deficiency anemia were 49.82% (15.58-84.07) and 20.17% (6.68-33.65) respectively. CONCLUSION Prevalence of anemia among TB patients was high especially among women. More than 43% of these patients suffered from moderate and severe anemia and about half of them had chronic disease anemia.
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Affiliation(s)
- Saeed Barzegari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahdi Afshari
- Department of Community Medicine, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Mahmood Moosazadeh
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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13
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Ezeamama AE, Sikorskii A, Bajwa RK, Tuke R, Kyeyune RB, Fenton JI, Guwatudde D, Fawzi WW. Evolution of Anemia Types During Antiretroviral Therapy-Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults. Nutrients 2019; 11:nu11040755. [PMID: 30935133 PMCID: PMC6521252 DOI: 10.3390/nu11040755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022] Open
Abstract
This study examined whether the type of anemia in persons living with HIV/AIDS (PLWHA) changed from the beginning of highly antiretroviral therapy (HAART) and had implications for treatment outcomes and quality of life (QOL). If present, the anemia-type was defined as microcytic, macrocytic or anemia of chronic disease (ACD) at study months 0, 6, 12, and 18. Multinomial logistic regression quantified sociodemographic and HIV-treatment factors associated with incident microcytic anemia or ACD over 18 months. Repeated measures linear regression models estimated the anemia-type associated change in the CD4 cell-count, QOL, body mass index (BMI) and frailty over 18 months. Cox proportional hazard models estimated associations between anemia-type and time to (a) gain at least 100 CD4 cells/L and (b) hospitalization/death. Analyses were implemented in Statistical Analysis Software (v.9.4) from which odds ratios (ORs) mean differences (β) and corresponding 95% confidence intervals (CI) were estimated. At enrollment, ACD, macrocytic and microcytic anemia was present in 36.8% (n = 147), 11.3% (n = 45) and 9.5% (n = 38), respectively with 42% (n = 170) anemia-free. By the study end, only 23% (n = 115) were without anemia. Among the 251 with anemia at the study end, 53.3% (n = 195) had macrocytic anemia, 12.8% (n = 47) had ACD and 2.5% (n = 9) had microcytic anemia. Incident macrocytic anemia was positively associated with baseline hyperferritinemia (OR = 1.85, 95%CI: 1.03⁻3.32), inversely associated with wealth (OR = 0.87, 95%CI: 0.67⁻1.03) and inversely associated with efavirenz-containing HAART (OR = 0.42, 95%CI: 0.21⁻0.85). ACD incidence decreased by 53% (95%CI: 0.27⁻0.79) per 100 cells/L increase in baseline CD4-cell count and decreased by 90% (95%CI: 0.01,0.87) among adults treated with nevirapine-containing HAART. ACD was associated with a lower BMI at months 6 (β = -0.33, 95% CI: -0.64, -0.01) and 12 (β = -0.41, 95%CI: -0.73, -0.09), with lower QOL (β = -3.2, 95%CI: -5.94, -0.53) at month 12 and with elevated frailty (β = 1.2; 95%CI: 0.46, 1.86) at month 12. Macrocytic anemia did not predict a post-enrollment change in CD4, BMI or QOL during follow-up. However, the time to gain 100 CD4 cells/L was 43% slower (p < 0.05) and the frailty was higher at month 12 for PLWHA with the baseline or sustained macrocytic vs. no anemia. A substantial decline in ACD and microcytic anemia occurred in tandem with large increase in the macrocytic anemia over 18 months on HAART. Interventions to mitigate all anemia-particularly ACD, is expected to improve the immune recovery rate, lower frailty, and enhanced QOL.
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Affiliation(s)
- Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA.
| | - Ramanpreet K Bajwa
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - Robert Tuke
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | | | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
| | - David Guwatudde
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7062 Kampala, Uganda.
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
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14
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Ezeamama AE, Guwatudde D, Sikorskii A, Kabagambe EK, Spelts R, Vahey G, Fenton JI, Fawzi WW. Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study. Nutrients 2018; 10:E475. [PMID: 29649107 PMCID: PMC5946260 DOI: 10.3390/nu10040475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022] Open
Abstract
Impaired hematologic status (IHS) was investigated as a determinant of immune function defined as cluster of differentiation 4 (CD4) T-helper cell count, quality of life (QOL) weight and hospitalization/mortality over 18-months among 398 adult persons living with HIV/AIDS (PLWHA) on anti-retroviral therapy. IHS was defined as having anemia at baseline (Hemoglobin: <12 g/dL for women and <13 g/dL for men), time-updated anemia or having low (<30 μg/L) or high (>200 μg/L for men and >150 μg/L for women) ferritin levels at baseline. Months-to-hospitalization/death or study-end (if no event) was calculated from enrollment. Multivariable linear-mixed models quantified associations between IHS and changes in CD4 cell-count, weight gain and QOL. Cox proportional hazards models calculated hazard ratios (HR) and corresponding 95% confidence intervals (CI) for IHS-related differences in time-to-hospitalization/death. The prevalences of anemia and high and low ferritin levels at baseline were 48.7% (n = 194), 40.5% (n = 161) and 17% (n = 68), respectively. Most patients (63.4%, n = 123) remained anemic during follow-up. Weight gained (ferritin-time interaction, p < 0.01) and QOL (anemia-time interaction, p = 0.05; ferritin-time interaction, p = 0.01) were lower for PLWHA with versus without IHS. Relative to anemia-free/normal ferritin, the risk of hospitalization/death was elevated for PLWHA with anemia (HR = 2.0; 95% CI: 1.2-3.6), low or high ferritin (HR: 1.8-1.9, 95% CI: 0.9-4.1) and those that developed new/persistent/progressive anemia (HR: 2.3-6.7, 95% CI: 1.0-12.7). Among PLWHA, IHS predicted deficits in QOL, low weight gain and a high risk of hospitalization/death. Intervention to mitigate persistent IHS may be warranted among PLWHA on long-term highly active antiretroviral therapy (HAART) to improve health outcomes.
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Affiliation(s)
- Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
| | - David Guwatudde
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA.
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA.
| | - Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN 37203, USA.
| | - Raybun Spelts
- College of Public Health, University of Georgia, Athens, GA 30602, USA.
| | - Grace Vahey
- College of Public Health, University of Georgia, Athens, GA 30602, USA.
| | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA.
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
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15
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Perumal R, Naidoo K, Padayatchi N. TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response. BMC Public Health 2018; 18:417. [PMID: 29587706 PMCID: PMC5872528 DOI: 10.1186/s12889-018-5362-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The global predominance of tuberculosis in men has received significant attention. However, epidemiological studies now demonstrate that there is an increased representation of young women with tuberculosis, especially in high HIV burden settings where young women bear a disproportionate burden of HIV. The role of the HIV epidemic, as well as changes in behavioural, biological, and structural risk factors are explored as potential explanations for the increasing burden of tuberculosis in young women. Discussion As young women are particularly vulnerable to HIV infection in sub-Saharan Africa, it is unsurprising that the TB epidemic in this setting has become increasingly feminised. This age-sex trend of TB in South Africa is similar to WHO estimates for other countries with a high HIV prevalence where there are more female than male cases notified up to the age of 25 years. The high prevalence of anaemia of chronic disease in young women with HIV is an additional potential reason for their increased TB risk. The widespread use of injectable medroxyprogesterone acetate contraception, which has been shown to possess selective glucocorticoid effect and oestrogen suppression, in young women may be an important emerging biological risk factor for tuberculosis in young women. Behavioural factors such as alcohol use and tobacco smoking patterns are further factors which may be responsible for the narrowing of the sex gap in TB epidemiology. In comparison to the significantly higher alcohol consumption rates in men globally, there is a narrowing gap in alcohol consumption between the sexes in South Africa with alarming rates of alcohol abuse in young women. There is a similar narrowing of the tobacco smoking gap between the sexes in South Africa, with increasing smoking prevalence in young women. Conclusion With nearly 70% of all TB patients being co-infected with HIV in our setting, it is not surprising that the age and sex distribution of TB is increasingly resembling the distribution of HIV in this region of dual hyperendemicity. New TB service design must begin to reflect the presence of young women as a significant group burdened by the disease.
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Affiliation(s)
- Rubeshan Perumal
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute (2nd floor), 719 Umbilo Road, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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16
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Ahmed A, Mekonnen D, Shiferaw AM, Belayneh F, Yenit MK. Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study. BMJ Open 2018; 8:e016961. [PMID: 29437750 PMCID: PMC5829770 DOI: 10.1136/bmjopen-2017-016961] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study assessed the incidence of tuberculosis (TB) and its predictors among adults living with HIV/AIDS in government health facilities in north-east Ethiopia. SETTING A 5-year retrospective cohort study was conducted from May to June 2015 on 451 adult HIV/AIDS-infected individuals who enrolled in the HIV care clinics of government health facilities in north-east Ethiopia. PARTICIPANTS A total of 451 HIV-infected adults who newly enrolled in the adult HIV care clinic from 1 July 2010 with complete information were followed until May 2015. PRIMARY OUTCOME MEASURE The primary outcome was the proportion of patients diagnosed with TB or the TB incidence rate. SECONDARY OUTCOME MEASURE The incidence of TB was investigated in relation to years of follow-up. RESULTS A total of 451 charts with complete information were followed for 1377.41 person-years (PY) of observation. The overall incidence density of TB was 8.6 per 100 PYof observation. Previous TB disease (adjusted HR (AHR) 3.65, 95% CI 1.97 to 6.73), being bedridden (AHR 5.45, 95% CI 1.16 to 25.49), being underweight (body mass index (BMI) <18.5 kg/m2) (AHR 2.53, 95 % CI 1.27 to 5.05), taking isoniazid preventive therapy (IPT) (AHR 0.14, 95% CI 0.05 to 0.39), haemoglobin below 11 g/dL (AHR 2.31, 95% CI 1.35 to 3.93), and being in WHO clinical stages III and IV (AHR 2.84, 95% CI 1.11 to 7.27; AHR 3.07, 95% CI 1.08 to 8.75, respectively) were significant for the incidence of TB. CONCLUSION The incidence of TB among adults living with HIV/AIDS in the first 3 years of follow-up was higher compared with that of subsequent years. Previous TB disease, no IPT, low BMI and haemoglobin level, advanced WHO clinical stage, and bedridden condition were the determinants of the incidence of TB. Therefore, addressing the significant predictors and improving TB/HIV collaborative activities should be strengthened in the study setting.
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Affiliation(s)
- Ausman Ahmed
- Department of Public Health, Jigjiga University, Jigjiga, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atsede M Shiferaw
- Department of Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Fanuel Belayneh
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Melaku K Yenit
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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17
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Hanifa Y, Fielding KL, Chihota VN, Adonis L, Charalambous S, Foster N, Karstaedt A, McCarthy K, Nicol MP, Ndlovu NT, Sinanovic E, Sahid F, Stevens W, Vassall A, Churchyard GJ, Grant AD. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. PLoS One 2017; 12:e0181519. [PMID: 28771504 PMCID: PMC5542442 DOI: 10.1371/journal.pone.0181519] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background The World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications. Objective To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation. Design Cohort study exploring a TB testing algorithm. Setting HIV clinics, South Africa. Participants Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model. Outcome TB, defined as “confirmed” if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and “clinical” if TB treatment started without microbiological confirmation, within six months of enrolment. Results Overall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4 (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested. Conclusion Our clinical score may help prioritise TB investigation among symptomatic individuals.
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Affiliation(s)
- Yasmeen Hanifa
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Violet N Chihota
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Foster
- Health Economics Unit, School of public health and family medicine, University of Cape Town, Cape Town, South Africa
| | - Alan Karstaedt
- Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mark P Nicol
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Johannesburg, South Africa
| | | | - Edina Sinanovic
- Health Economics Unit, School of public health and family medicine, University of Cape Town, Cape Town, South Africa
| | - Faieza Sahid
- Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- National Health Laboratory Service, Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Vassall
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gavin J Churchyard
- London School of Hygiene & Tropical Medicine, London, United Kingdom.,The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Advancing Treatment and Care for TB/HIV, South African Medical Research Council Collaborating Centre for HIV and TB, Johannesburg, South Africa
| | - Alison D Grant
- London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Nursing and Public Health, Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
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18
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Mntonintshi M, O'Mahony D, Mabunda S, Namugenyi KAF. Undiagnosed tuberculosis in patients with HIV infection who present with severe anaemia at a district hospital. Afr J Prim Health Care Fam Med 2017; 9:e1-e6. [PMID: 28697621 PMCID: PMC5506498 DOI: 10.4102/phcfm.v9i1.1406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/09/2017] [Indexed: 01/26/2023] Open
Abstract
Background Tuberculosis (TB) is a major cause of severe anaemia in patients with human immunodeficiency virus (HIV) infection in South Africa. However, TB can be difficult to diagnose as it may be extra pulmonary and paucibacillary. Aim The aim of this study was to investigate undiagnosed TB in patients with HIV infection and severe anaemia and to identify the optimal investigations for diagnosing TB. Setting Mthatha General Hospital, a district hospital. Methods The study was a case series. Results Haemoglobin levels ranged from 3.6 g/dL to 7.9 g/dL, the mean CD4 count was 176 cells/μL and 80% of patients had a positive TB symptom screen. Forty-three (86%) patients had either clinical or bacteriologically proven TB of whom 33 had pulmonary TB, 34 had extra pulmonary TB and 24 had both types. The diagnostic yield for TB was: chest X-ray (CXR) 91%; ultrasound (US) abdomen pericardium and lower chest 62%; sputum Xpert MTB/RIF 35%; TB blood culture 21% and TB urine culture 15%. Blood and urine cultures did not identify any additional cases over those identified by CXR and US. The laboratory turnaround times were as follows: sputum Xpert, 1.6 days; blood culture, 20 days and urine culture, 28 days. CXR and US were done within one day of initial patient assessment. Conclusions The majority of HIV patients with severe anaemia had TB disease, and extra pulmonary TB was as prevalent as pulmonary TB. CXR, US and sputum Xpert were the optimum tests for rapid diagnosis of TB. South African national TB/HIV guidelines should incorporate these specific tests to diagnose TB in patients with HIV and severe anaemia.
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Affiliation(s)
| | - Don O'Mahony
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University.
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19
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Saavedra A, Campinha-Bacote N, Hajjar M, Kenu E, Gillani FS, Obo-Akwa A, Lartey M, Kwara A. Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital. Pan Afr Med J 2017; 27:48. [PMID: 28819470 PMCID: PMC5554638 DOI: 10.11604/pamj.2017.27.48.8917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/27/2017] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION This study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH). METHODS The retrospective study reviewed the medical records of 547 HIV-infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests. RESULTS Of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 124 (55.9%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05). CONCLUSION The inpatient mortality rate among HIV-infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths.
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Affiliation(s)
| | | | - Maurice Hajjar
- Warren Alpert Medical School of Brown University, RI, USA
| | - Ernest Kenu
- Department of Medicine, Korle Bu Teaching Hospital, Korle-Bu Accra
| | - Fizza Syeda Gillani
- Warren Alpert Medical School of Brown University, RI, USA.,The Miriam Hospital, Providence, RI, USA
| | - Adjoa Obo-Akwa
- Department of Medicine, University of Ghana School of Medicine & Dentistry, College of Health Sciences, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, Korle Bu Teaching Hospital, Korle-Bu Accra.,Department of Medicine, University of Ghana School of Medicine & Dentistry, College of Health Sciences, Accra, Ghana
| | - Awewura Kwara
- Brown University, Providence, RI, USA.,Warren Alpert Medical School of Brown University, RI, USA.,The Miriam Hospital, Providence, RI, USA.,University of Florida College of Medicine, Gainesville, FL, USA
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20
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Adamu AL, Crampin A, Kayuni N, Amberbir A, Koole O, Phiri A, Nyirenda M, Fine P. Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences. Popul Health Metr 2017; 15:12. [PMID: 28356159 PMCID: PMC5371260 DOI: 10.1186/s12963-017-0128-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 03/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global burden of anemia is large especially in sub-Saharan Africa, where HIV is common and lifestyles are changing rapidly with urbanization. The effects of these changes are unknown. Studies of anemia usually focus on pregnant women or children, among whom the burden is greatest. We describe prevalence and risk factors for anemia among rural and urban men and women of all ages in Malawi. METHODS We analyzed data from a population-wide cross-sectional survey of adults conducted in two sites, Karonga (rural) and Lilongwe (urban), commencing in May 2013. We used multinomial logistic regression models, stratified by sex to identify risk factors for mild and moderate-to-severe anemia. RESULTS Anemia prevalence was assessed among 8,926 men (age range 18-100 years) and 14,978 women (age range: 18-103 years). Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 8.2, 6.7 and 1.2% in rural men; 19.4, 12.0 and 7.4% in rural women; 5.9, 5.1 and 0.8% in urban men; and 23.4, 13.6 and 10.1% in urban women. Among women, the odds of anemia were higher among urban residents and those with higher socioeconomic status. Increasing age was associated with higher anemia prevalence in men. Among both men and women, HIV infection was a consistent risk factor for severity of anemia, though its relative effect was stronger on moderate-to-severe anemia. CONCLUSIONS The drivers of anemia in this population are complex, include both socioeconomic and biological factors and are affecting men and women differently. The associations with urban lifestyle and HIV indicate opportunities for targeted intervention.
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Affiliation(s)
| | - Amelia Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Ndoliwe Kayuni
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Alemayehu Amberbir
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Olivier Koole
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Amos Phiri
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Moffat Nyirenda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Paul Fine
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Fiseha T, Tamir Z, Seid A, Demsiss W. Prevalence of anemia in renal insufficiency among HIV infected patients initiating ART at a hospital in Northeast Ethiopia. BMC HEMATOLOGY 2017; 17:1. [PMID: 28116101 PMCID: PMC5240406 DOI: 10.1186/s12878-017-0071-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/01/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anemia is a strong predictor of mortality and poor quality of life among persons with either renal impairment or HIV infection. In this study, we investigated the prevalence of anemia and its association with renal insufficiency among HIV infected patients initiating ART at a hospital in Northeast Ethiopia. METHODS In this retrospective cohort study, records of 373 patients on ART were selected in Dessie Referral hospital, South Wollo, Northeast Ethiopia from September 2010 to August 2013. Socio-demographic and clinical characteristics of the study patients were collected using standardized data extraction instrument. The abbreviated 4-variable Modification of Diet in Renal Disease (MDRD) study equation was used to estimate renal function (GFR) from serum creatinine. SPSS version 20.0 statistical software was used for data analysis. RESULTS The prevalence of anemia at the time of ART initiation was 34.4%; with 20.5, 12.3 and 1.6% mild, moderate and severe anemia, respectively. Renal insufficiency was present in 27.9% of patients and was associated with a high prevalence of anemia (74%). The prevalence of anemia increased with stage of insufficiency, from 23.7% in stage 1 to 100% in stage 4. Impaired renal function (eGFR < 60 mL/min/1.73 m2) was associated with a higher risk of all forms of anemia; i.e., mild (AOR = 3.96; 95% CI: 2.76-5.69), moderate (AOR = 2.21; 95% CI: 1.16-4.19) and severe anemia (AOR = 5.89; 95% CI: 1.02-12.03). CONCLUSION HIV infected patients with renal insufficiency had a higher prevalence of anemia compared to patients with normal renal function. Thus, screening of these patients for anemia and renal insufficiency at base line should be critical not only to reduce mortality but also to improve clinical outcomes.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zemenu Tamir
- Department of Clinical Laboratory Science, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abdurahaman Seid
- Department of Clinical Laboratory Science, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondmagegn Demsiss
- Department of Clinical Laboratory Science, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
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22
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Kerkhoff AD, Meintjes G, Opie J, Vogt M, Jhilmeet N, Wood R, Lawn SD. Anaemia in patients with HIV-associated TB: relative contributions of anaemia of chronic disease and iron deficiency. Int J Tuberc Lung Dis 2017; 20:193-201. [PMID: 26792471 PMCID: PMC6371921 DOI: 10.5588/ijtld.15.0558] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: Anaemia commonly complicates both human immunodeficiency virus (HIV) infection and tuberculosis (TB), contributing substantially to morbidity and mortality. The mechanisms underlying anaemia and corresponding treatments in co-infected patients are poorly defined. OBJECTIVE: To determine the relative contributions of anaemia of chronic disease (ACD) and iron deficiency to anaemia in patients with HIV-associated TB. DESIGN: Consecutively recruited hospitalised (n = 102) and matched ambulatory patients (n = 51) with microbiologically confirmed HIV-associated TB in Cape Town, South Africa, were included. Haemoglobin levels, iron status markers, hepcidin and pro-inflammatory cytokines in blood were measured. We determined the prevalence of ACD and iron-deficiency anaemia (IDA) using seven different published definitions of IDA. RESULTS: More than 80% of enrolled HIV-associated TB patients were anaemic, and anaemia was more severe among in-patients. Over 95% of anaemic HIV-associated TB patients had ACD, whereas the proportion with IDA using a range of seven different definitions was low overall (median < 3%, range 0–32.6) in both patient groups. The proportion with IDA and hepcidin concentration ⩽ 20.0 ng/ml (predictive of responsiveness to oral iron supplementation) was also very low (median < 3%, range 0–15.1). CONCLUSIONS: ACD was the predominant cause underlying anaemia in HIV-associated TB patients, and IDA was very uncommon in this setting. The majority of anaemic HIV-associated TB patients were unlikely to benefit from oral iron supplementation.
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Affiliation(s)
- A D Kerkhoff
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA; Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands; The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Meintjes
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College, London, UK
| | - J Opie
- Division of Haematology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; C17 Clinical Pathology Laboratory, National Health Laboratory Service and Groote Schuur Hospital, Cape Town, South Africa
| | - M Vogt
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N Jhilmeet
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - R Wood
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S D Lawn
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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23
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Mulenga CM, Kayembe JMN, Kabengele BO, Bakebe A. Anemia and Hematologic Characteristics in Newly Diagnosed Pulmonary Tuberculosis Patients at Diagnosis in Kinshasa. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jtr.2017.54026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thi AM, Shewade HD, Kyaw NTT, Oo MM, Aung TK, Aung ST, Oo HN, Win T, Harries AD. Timing of antiretroviral therapy and TB treatment outcomes in patients with TB-HIV in Myanmar. Public Health Action 2016; 6:111-7. [PMID: 27358804 PMCID: PMC4913673 DOI: 10.5588/pha.16.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/25/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING Integrated HIV Care programme, Mandalay, Myanmar. OBJECTIVES To determine time to starting antiretroviral treatment (ART) in relation to anti-tuberculosis treatment (ATT) and its association with TB treatment outcomes in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) enrolled from 2011 to 2014. DESIGN Retrospective cohort study. RESULTS Of 1708 TB-HIV patients, 1565 (92%) started ATT first and 143 (8%) started ART first. Treatment outcomes were missing for 226 patients and were thus not included. In those starting ATT first, the median time to starting ART was 8.6 weeks. ART was initiated after 8 weeks in 830 (53%) patients. Unsuccessful outcome was found in 7%, with anaemia being an independent predictor. In patients starting ART first, the median time to starting ATT was 21.6 weeks. ATT was initiated within 3 months in 56 (39%) patients. Unsuccessful outcome was found in 12%, and in 20% of those starting ATT within 3 months. Patients with CD4 count <100/mm(3) had a four times higher risk of an unsuccessful outcome. CONCLUSIONS Timing of ART in relation to ATT was not an independent risk factor for unsuccessful outcome. Extensive screening for TB with rapid and sensitive diagnostic tests in HIV-infected persons and close monitoring of anaemia and immunosuppression are recommended to further improve TB treatment outcomes among patients with TB-HIV.
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Affiliation(s)
- A. M. Thi
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | | | - N. T. T. Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - M. M. Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - T. K. Aung
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - S. T. Aung
- National Tuberculosis Programme, Ministry of Health, Nay Pyi Taw, Myanmar
| | - H. N. Oo
- National AIDS Programme (NAP), Ministry of Health, Nay Pyi Taw, Myanmar
| | - T. Win
- NAP, Ministry of Health, Mandalay, Myanmar
| | - A. D. Harries
- The Union, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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25
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Kerkhoff AD, Lawn SD, Schutz C, Burton R, Boulle A, Cobelens FJ, Meintjes G. Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa. Open Forum Infect Dis 2015; 2:ofv173. [PMID: 26730391 PMCID: PMC4693115 DOI: 10.1093/ofid/ofv173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022] Open
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.
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Affiliation(s)
- Andrew D Kerkhoff
- 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
| | - Stephen D Lawn
- 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
| | - Charlotte Schutz
- 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
| | - Rosie Burton
- Department of Medicine, Faculty of Health Sciences, University of Cape Town; Khayelitsha District Hospital, Cape Town
| | - Andrew Boulle
- 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
| | - Frank J Cobelens
- 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
| | - Graeme Meintjes
- 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
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26
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Akilimali PZ, Kashala-Abotnes E, Musumari PM, Kayembe PK, Tylleskar T, Mapatano MA. Predictors of Persistent Anaemia in the First Year of Antiretroviral Therapy: A Retrospective Cohort Study from Goma, the Democratic Republic of Congo. PLoS One 2015; 10:e0140240. [PMID: 26474481 PMCID: PMC4608787 DOI: 10.1371/journal.pone.0140240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/23/2015] [Indexed: 01/13/2023] Open
Abstract
Background Anaemia is associated with adverse outcomes including early death in the first year of antiretroviral therapy (ART). This study reports on the factors associated with persistent anaemia among HIV-infected patients initiating ART in the Democratic Republic of Congo (DR Congo). Methods We conducted a retrospective cohort study and analyzed data from patients receiving HIV care between January 2004 and December 2012 at two major hospitals in Goma, DR Congo. Haemoglobin concentrations of all patients on ART regimen were obtained prior to and within one year of ART initiation. A logistic regression model was used to identify the predictors of persistent anaemia after 12 months of ART. Results Of 756 patients, 69% of patients were anaemic (IC95%: 65.7–72.3) at baseline. After 12 months of follow up, there was a 1.2 g/dl average increase of haemoglobin concentration (P < 0.001) with differences depending on the therapeutic regimen. Patients who received zidovudine (AZT) gained less than those who did not receive AZT (0.99 g/dl vs 1.33 g/dl; p< 0.001). Among 445 patient who had anaemia at the beginning, 33% (147/445) had the condition resolved. Among patients with anaemia at ART initiation, those who did not receive cotrimoxazole prophylaxis before starting ART(AOR 3.89; 95% CI 2.09–7.25; P < 0.001) and a AZT initial regimen (AOR 2.19; 95% CI 1.36–3.52; P < 0.001) were significantly at risk of persistent anaemia. Conclusions More than two thirds of patients had anaemia at baseline. The AZT-containing regimen and absence of cotrimoxazole prophylaxis before starting ART were associated with persistent anaemia 12 months, after initiation of treatment. Considering the large proportion of patients with persistence of anaemia at 12 months, we suggest that it is necessary to conduct a large study to assess anaemia among HIV-infected patients in Goma.
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Affiliation(s)
- Pierre Zalagile Akilimali
- Kinshasa University School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- * E-mail:
| | | | - Patou Masika Musumari
- Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Patrick Kalambayi Kayembe
- Kinshasa University School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Mala Ali Mapatano
- Kinshasa University School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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27
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Kerkhoff AD, Meintjes G, Burton R, Vogt M, Wood R, Lawn SD. Relationship Between Blood Concentrations of Hepcidin and Anemia Severity, Mycobacterial Burden, and Mortality Among Patients With HIV-Associated Tuberculosis. J Infect Dis 2015; 213:61-70. [PMID: 26136467 PMCID: PMC4676545 DOI: 10.1093/infdis/jiv364] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/22/2015] [Indexed: 12/02/2022] Open
Abstract
Background Anemia is very common in patients with human immunodeficiency virus (HIV)–associated tuberculosis, and hepcidin may be key in mediating this. We explored the relationship between blood hepcidin concentrations and anemia severity, mycobacterial burden and mortality in patients with HIV-associated tuberculosis. Methods Consecutive unselected HIV-infected adults in South Africa were systematically investigated for tuberculosis. Three groups were studied: 116 hospitalized inpatients with HIV infection and tuberculosis (hereafter, “hospitalized patients”), 58 ambulatory outpatients with HIV infection and newly diagnosed tuberculosis (hereafter, “ambulatory patients with tuberculosis”), and 58 ambulatory outpatients with HIV infection and without tuberculosis (hereafter, “ambulatory patients without tuberculosis”). Blood hepcidin concentrations were determined for all patients. Vital status at 3 months was determined, and independent predictors of mortality were identified. Results Median hepcidin concentrations were 38.8 ng/mL among hospitalized patients, 19.1 ng/mL among ambulatory patients with tuberculosis, and 5.9 ng/mL among ambulatory patients without tuberculosis (P < .001). In both groups with HIV-associated tuberculosis, hepcidin concentrations were strongly associated with greater anemia severity. Additionally, strong, graded associations were observed between hepcidin and composite indices of mycobacterial burden and dissemination. Patients dying within 3 months had significantly higher hepcidin concentrations, which independently predicted mortality. Conclusions High hepcidin concentrations were strongly associated with disseminated disease, anemia, and poor prognosis in patients with HIV-associated tuberculosis. Hepcidin may be a mechanistically important mediator underlying the high prevalence of severe anemia in these patients.
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Affiliation(s)
- Andrew D Kerkhoff
- 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 The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine
| | - Graeme Meintjes
- Department of Medicine, Faculty of Health Sciences Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Department of Medicine, Imperial College
| | - Rosie Burton
- Department of Medicine, Khayelitsha District Hospital, Cape Town, South Africa
| | - Monica Vogt
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine
| | - Robin Wood
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Stephen D Lawn
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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Kerkhoff AD, Wood R, Cobelens FG, Gupta-Wright A, Bekker LG, Lawn SD. The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study. BMC Med 2015; 13:70. [PMID: 25889688 PMCID: PMC4411796 DOI: 10.1186/s12916-015-0320-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low haemoglobin concentrations may be predictive of incident tuberculosis (TB) and death in HIV-infected patients receiving antiretroviral therapy (ART), but data are limited and inconsistent. We examined these relationships retrospectively in a long-term South African ART cohort with multiple time-updated haemoglobin measurements. METHODS Prospectively collected clinical data on patients receiving ART for up to 8 years in a community-based cohort were analysed. Time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded, and TB diagnoses and deaths from all causes were ascertained. Anaemia severity was classified using World Health Organization criteria. TB incidence and mortality rates were calculated and Poisson regression models were used to identify independent predictors of incident TB and mortality, respectively. RESULTS During a median follow-up of 5.0 years (IQR, 2.5-5.8) of 1,521 patients, 476 cases of incident TB and 192 deaths occurred during 6,459 person-years (PYs) of follow-up. TB incidence rates were strongly associated with time-updated anaemia severity; those without anaemia had a rate of 4.4 (95%CI, 3.8-5.1) cases/100 PYs compared to 10.0 (95%CI, 8.3-12.1), 26.6 (95%CI, 22.5-31.7) and 87.8 (95%CI, 57.0-138.2) cases/100 PYs in those with mild, moderate and severe anaemia, respectively. Similarly, mortality rates in those with no anaemia or mild, moderate and severe time-updated anaemia were 1.1 (95%CI, 0.8-1.5), 3.5 (95%CI, 2.7-4.8), 11.8 (95%CI, 9.5-14.8) and 28.2 (95%CI, 16.5-51.5) cases/100 PYs, respectively. Moderate and severe anaemia (time-updated) during ART were the strongest independent predictors for incident TB (adjusted IRR = 3.8 [95%CI, 3.0-4.8] and 8.2 [95%CI, 5.3-12.7], respectively) and for mortality (adjusted IRR = 6.0 [95%CI, 3.9-9.2] and adjusted IRR = 8.0 [95%CI, 3.9-16.4], respectively). CONCLUSIONS Increasing severity of anaemia was associated with exceptionally high rates of both incident TB and mortality during long-term ART. Patients receiving ART who have moderate or severe anaemia should be prioritized for TB screening using microbiological assays and may require adjunctive clinical interventions.
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Affiliation(s)
- Andrew D Kerkhoff
- George Washington University School of Medicine and Health Sciences, 2300 Eye St, NW, Washington, DC, 20037, USA. .,Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, the Netherlands. .,The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Robin Wood
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Frank G Cobelens
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, the Netherlands. .,KNCV Tuberculosis Foundation, The Hague, the Netherlands.
| | - Ankur Gupta-Wright
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Stephen D Lawn
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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