TY - JOUR
T1 - Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality
AU - Huibers, Minke H. W.
AU - Bates, Imelda
AU - McKew, Steve
AU - Allain, Theresa J.
AU - Coupland, Sarah E.
AU - Phiri, Chimota
AU - Phiri, Kamija S.
AU - van Hensbroek, Michael Boele
AU - Calis, Job C.
PY - 2020
Y1 - 2020
N2 - Background Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology are lacking but are needed to improve outcomes. Methods HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤ 50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes and associations with anaemia severity and mortality were explored. Results 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. More than two potential causes for anaemia were present in 94% of the patients including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB infection (41.2%) and unsuppressed HIV infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1–6.9). Overall mortality was high (53%; 100/199) with a median time to death of 17.5 days (IQR 6–55) days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2–3.8) and end stage renal disease (HR 3.2; 95% CI 1.6–6.2). Conclusion Mortality among severely anaemic HIV-infected adults is strikingly high. Clinicians should be aware of the urgent need for a multifactorial approach including starting or optimising HIV treatment, considering TB treatment, nutritional support and optimising renal management.
AB - Background Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology are lacking but are needed to improve outcomes. Methods HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤ 50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes and associations with anaemia severity and mortality were explored. Results 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. More than two potential causes for anaemia were present in 94% of the patients including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB infection (41.2%) and unsuppressed HIV infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1–6.9). Overall mortality was high (53%; 100/199) with a median time to death of 17.5 days (IQR 6–55) days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2–3.8) and end stage renal disease (HR 3.2; 95% CI 1.6–6.2). Conclusion Mortality among severely anaemic HIV-infected adults is strikingly high. Clinicians should be aware of the urgent need for a multifactorial approach including starting or optimising HIV treatment, considering TB treatment, nutritional support and optimising renal management.
UR - http://www.scopus.com/inward/record.url?scp=85080069561&partnerID=8YFLogxK
U2 - https://doi.org/10.1371/journal.pone.0218695
DO - https://doi.org/10.1371/journal.pone.0218695
M3 - Article
C2 - 32097440
SN - 1932-6203
VL - 15
JO - PLOS ONE
JF - PLOS ONE
IS - 2
M1 - e0218695
ER -