Incidence and predictors of recovery from anaemia among patients on antiretroviral therapy within the Themba-Lethu clinical cohort, from 2004-2010
Introduction Anaemia is one of the most frequent haematological complications seen in people with HIV/AIDS. Understanding factors associated with recovery from anaemia during Highly Active Antiretroviral Therapy (HAART) is vital since anaemia is a strong predictor of disease progression and mortality. However to our knowledge, predictors of recovery from anaemia in HIV infected patients are not well documented. Methods The study was a retrospective analysis of data prospectively collected from Themba-Lethu Clinic HIV cohort. A total of 12,441 adult patients initiating HAART between 1st April 2004 and 30th June 2010 were analyzed. A further 2,489 patients with anaemia at HAART initiation were examined to determine incidence and predictors of recovery from anaemia. Kaplan-Meier methods were used to estimate time to recovery from anaemia and Cox proportional hazard models were fitted to investigate predictors of recovery from anaemia. Results Among these 12,441 participants at HAART initiation, 7,645 (61.5%) were females and the median age of the participants was 36.4 years (IQR: 31.3 - 42.9). The mean haemoglobin level was 11.4 g/dl (SD: 2.23) and the overall prevalence of anaemia (Hb<10 g/dl) was 27%. The majority of patients had WHO HIV/AIDS clinical stage 1 (n=4,474; 36.0%), and TB was present in 1,953 (15.7%) patients. Mean CD4 cell count was 101 cells/mm3 (SD=76.0) with 6,745 (54.2%) having CD4 cell count <100 cells/mm3. At the end of follow-up, 48.1% of the cohort was still alive, while 37.6% were lost to follow up and 14.3% were dead. Of the 2,489 anaemic patients at HAART initiation, 2,225 (89.4%) recovered from anaemia. The median time for anaemia recovery was 3.88 months [IQR: 3.22 - 6.20 months] and incidence rate of recovery was 180 (95% CI: 172-187) per 100 person years. Sex, baseline CD4 cell count, BMI, WHO HIV/AIDS clinical staging, employed, smoking, TB at initiation of HAART, TB after initiation, still on first regimen and education category were significant predictors of recovery from anaemia in the Cox univariate analysis. However, in the adjusted analysis, predictors of recovery from anaemia which remained significant were: sex [HR: 1.44, (95% CI: 1.30-1.70) p<0.001], baseline CD4 cell count [HR: 0.99, (95% CI: 0.99-1.00) p=0.05], baseline WHO HIV/AIDS clinical staging [HR: 0.83, (95% CI: 0.65-0.97) p=0.017] and HIV viral load [HR: 0.93, (95% CI: 0.79-1.09) p=0.359]. Conclusion To our knowledge, this is the first study to look into predictors of recovery from anaemia in sub-Saharan Africa. Anaemic individuals within HIV cohorts should be promptly identified and predictors of recovery from anaemia must be used for intensive case management and monitoring.