Article

Prevalence, incidence and predictors of severe anemia with zidovudine-containing regimens in Afircan adults with HIV infection within the DART trial

Joint Clinical Research Centre, Kampala, Uganda.
Antiviral therapy (Impact Factor: 3.14). 01/2006; 11(6):741-9.
Source: PubMed

ABSTRACT To describe the prevalence, incidence and predictors of severe anaemia in previously untreated symptomatic HIV-infected adults with CD4+ T-cells <200 cells/mm(3) initiating zidovudine-containing regimens in Africa.
DART is a randomized trial comparing two strategies for HIV/AIDS management in Uganda and Zimbabwe.
We analysed the occurrence of anaemia at weeks 4 and 12, and then every 12 weeks. We also evaluated sex, age, WHO stage, body mass index (BMI), baseline laboratory measurements and first regimen as predictors of developing grade 4 anaemia (<6.5 mg/dl) by week 48 using logistic regression.
To May 2005, 3,314 participants (65% women, 23% at WHO stage 4, median age=37 years, baseline CD4+ T-cell=86 cells/mm(3) and median baseline haemoglobin=11.4 g/dl) had a median 72 weeks follow-up. Prevalence of grade 4 anaemia was 0.70, 2.0%, 0.5% and <0.5% at weeks 4, 12, 24 and > or =36, respectively. Overall, 219 (6.6%) participants developed grade 4 anaemia by week 48; women and those with lower haemoglobin, CD4+ T-cell count and BMI at baseline were at significantly higher risk (P<0.05), but not those with lower neutrophils or receiving cotrimoxazole at baseline.
We observed a higher incidence of grade 4 anaemia than in studies from industrialized countries, which is likely to be due in part to population characteristics and in part to a higher rate of concurrent HIV-related clinical events. Clinical vigilance and haemoglobin measurements 4, 8 and 12 weeks after starting zidovudine could help to manage serious anaemia.

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    • "Amongst patients in an urban HIV clinic in Uganda, severe anemia improved with ART in the majority of patients. These findings suggested that baseline severe anemia should not be used as a criterion for avoiding the use of zidovudine in patients initiating ART in resource-limited settings [15] [16]. "
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    • "The proportion of patients seen with peripheral neuropathy (9%), anaemia (3%), drug rash (2%) and psychosis (1%) in this study was lower than those reported in other studies (Ssali et al. 2006). Our cohort has been maintained for over a decade using the same methods for clinical, laboratory and data management (French et al. 2000; Watera et al. 2006). "
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    • "The detection and treatment of anaemia is important especially for patients who are about to start zidovudine-containing regimens of HAART. In another study from Uganda, participants with low haemoglobin who were started on a zidovudine containing regimen had an increased risk of developing grade 4 anaemia (Ssali et al. 2006). "
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