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

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. HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤ 50 g/...

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Bibliographic Details
Published in:PloS one 2020-02, Vol.15 (2), p.e0218695-e0218695
Main Authors: Huibers, Minke H W, Bates, Imelda, McKew, Steve, Allain, Theresa J, Coupland, Sarah E, Phiri, Chimota, Phiri, Kamija S, Boele van Hensbroek, Michael, Calis, Job C
Format: Article
Language:English
Subjects:
Adult
Adults
AIDS treatment
Anemia
Anemia, Iron-Deficiency - complications
Anemia, Iron-Deficiency - epidemiology
Anemia, Iron-Deficiency - etiology
Antiretroviral therapy
Automation
Biology and Life Sciences
Bone marrow
Children & youth
Childrens health
Chronic kidney failure
Diseases
Etiology
Female
Folic acid
Health aspects
Hemoglobin
Hemoglobins
Herpesviridae Infections - complications
Herpesviridae Infections - epidemiology
HIV
HIV Infections - complications
HIV Infections - epidemiology
HIV patients
Hospital patients
Hospitals
Human immunodeficiency virus
Humans
Infections
Internal medicine
Iron
Iron deficiency
Kidney diseases
Laboratories
Malaria
Malawi
Male
Malnutrition - complications
Malnutrition - epidemiology
Medical schools
Medicine
Medicine and Health Sciences
Middle Aged
Morbidity
Mortality
Nutrient deficiency
Patients
Studies
Sub-Saharan Africa
Tanzania
Time
Tuberculosis
Tuberculosis - complications
Tuberculosis - epidemiology
Underweight
United Kingdom
X-rays
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Summary: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. 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. 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 (BMI1000 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). 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0218695