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

Huibers, Minke HW, Bates, Imelda, McKew, Steve, Allain, Theresa J, Coupland, Sarah E ORCID: 0000-0002-1464-2069, Phiri, Chimota, Phiri, Kamija S, van Hensbroek, Michael Boele and Calis, Job C
(2020) Severe anaemia complicating HIV in Malawi; Multiple co-existing aetiologies are associated with high mortality. PLOS ONE, 15 (2). e0218695-.

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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.

Item Type: Article
Uncontrolled Keywords: Humans, Tuberculosis, Herpesviridae Infections, HIV Infections, Anemia, Iron-Deficiency, Malnutrition, Mortality, Adult, Middle Aged, Female, Male
Depositing User: Symplectic Admin
Date Deposited: 10 Mar 2020 11:15
Last Modified: 18 Jan 2023 23:58
DOI: 10.1371/journal.pone.0218695
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