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

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Huibers, Minke HW, Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199, McKew, Steve, Allain, Theresa J, Coupland, Sarah E, Phiri, Chimota, Phiri, Kamija S, Boele van Hensbroek, Michael and Calis, Job C (2020) 'Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality'. PLoS ONE, Vol 15, Issue 2, e0218695.

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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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0218695
Depositing User: Rachel Dominguez
Date Deposited: 28 Feb 2020 12:45
Last Modified: 28 Feb 2020 16:24
URI: https://archive.lstmed.ac.uk/id/eprint/13854

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