Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality

Minke H. W. Huibers, Imelda Bates, Steve McKew, Theresa J. Allain, Sarah E. Coupland, Chimota Phiri, Kamija S. Phiri, Michael Boele van Hensbroek, Job C. Calis

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Abstract

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.
Original languageEnglish
Article numbere0218695
JournalPLOS ONE
Volume15
Issue number2
DOIs
Publication statusPublished - 2020

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