HAART improves anaemia in HIV-positive patients

Anaemia is common in HIV infection, and the likelihood of anaemia increases significantly as the patient progresses from asymptomatic HIV infection to immunologic and clinical AIDS.

In prior studies involving HIV-infected patients, anaemia has been found to correlate with the patients’ overall quality of life and to be independently associated with increased morbidity and mortality. Generally, the correction of anaemia leads to improved quality of life and decreases in morbidity and mortality in HIV-infected patients. Thus, monitoring HIV-infected patients for anaemia and, when found, the institution of appropriate treatment may have a significant impact upon the overall health and quality of life of HIV-infected patients.

In order to determine how highly active antiretroviral therapy (HAART) and other factors affected anaemia in HIV-infected patients, researchers at Johns Hopkins analysed data from 905 patients who received HIV care at that centre after 1 July, 1996. Analyses were done of haemoglobin levels obtained at baseline and during one year of follow-up in patients who received and did not receive a HAART regimen.

The researchers found that at baseline 11% of patients had a haemoglobin count <10 g/dL, 27% had a haemoglobin count 10 to 12 g/dL, and 21% had a haemoglobin count of >14 g/dL at baseline before HAART was started. During one year of follow-up, 42% of the patients on HAART achieved a haemoglobin level >14 g/dL. In contrast, only 31% of patients who did not use HAART achieved that haemoglobin level.

The use of zidovudine (ZDV) in the HAART regimen did not appear to have an impact upon the overall effectiveness of HAART in improving anaemia outcomes. Using a multivariate analysis, after adjustment for gender, race, injection drug use history, baseline CD4 and HIV-1 RNA levels, and anaemia treatments, the use of HAART was strongly associated with not having anaemia during one year of follow-up.

Based upon these findings, the authors conclude, in line with prior studies, “HAART is an effective treatment of the anaemia of HIV infection.” While other studies have indicated that patients on HAART regimens that include ZDV do not achieve haemoglobin levels comparable to those on HAART regimens that do not contain ZDV, this study failed to find that ZDV had a significant impact upon haemoglobin recovery.

Still, clinicians confronted with an anaemic, HIV-infected patient should design a HAART regimen most likely to lead to improved haemoglobins, and given its known impact upon haemoglobin – especially in patients with AIDS – consideration should be given to AZT-sparing regimens, if that option exists. Further, a thorough anaemia workup and adjunctive therapy, where appropriate, should also be considered.

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