16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

ANEMIA IN EARLY STAGES OF HIV-1 INFECTION IN ADULTS IN BOTSWANA, AFRICA

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0205

Sales S.¹, Campa A.¹, Essex M.², Wester W.³, Redd A.², Burns P.², Duan R.¹, Xue L.¹, Bussman H.³, Arimi P.³, Widenfelt E.³, Thior I.³, Makhema J.³, Marlink R.², Baum M.K.¹, Micronutrient Study Team
¹ Florida International University, Stempel School of Public Health, Miami, United States, ² Harvard University, School of Public Health, Boston, United States, ³ Botswana Harvard School of Public Health AIDS Initiative (BHP), Gaborone, Botswana

BACKGROUND: Anemia is independently associated with HIV mortality and is the most common hematological abnormality in HIV-infection, associated with AIDS, high viral load, female gender, and African American ethnicity. Virological evidence indicates that HIV-1 subtype C affects hematopoiesis, possibly through heightened HIV-1C viral affinity to infiltrate the bone marrow and affect erythroblast precursors. We investigated the prevalence of anemia and its association with disease progression in an ARV-naïve cohort who are early in HIV disease in Botswana, Africa.

METHODS: After obtaining informed consent, blood was drawn for viral load, CD4 count, ferritin and indices of anemia defined as hemoglobin <12g/dL, hematocrit <37% for women, and hemoglobin <14 g/dL, hematocrit <42% for men.

RESULTS: Of the 335 participants, the mean age was 33.8±8.09 and 85.5% were women; the mean CD4 count was 461±206 cells/µL. Anemia occurred in 34% of the cohort, more frequently in women (36.7%) than in men (22.5%). Of those with anemia, 77.4% had normocytic/normochormic and 21.4% had microcytic/hypochromic anemia; only 11.7% could be attributed to iron deficiency (ferritin <12ng/dL). Anemia was independently associated with viral load (p=0.048) even after controlling for gender, age and CD4 count. Participants with anemia had higher chance of having viral load over 5000 copies/mL than those without anemia (OR=1.76;CI:1.1,2.9, p=0.027) and remained significant when controlled for inflammation with LDH (OR=1.77;CI: 1.02,3.08, p=0.042). The risk of anemia was higher as viral load increased (OR=1.35, CI:1.00,1.81, p=0.047).

CONCLUSIONS: Anemia was prevalent in this African cohort in early stages of HIV-1C disease. Since anemia has been found independently related to HIV mortality, efforts to better monitor, diagnose and treat are needed in the region. Additional studies on types of anemia among patients with early HIV-1C infection and its association to viral characteristics are needed.

Funded by NIDA

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2006-08-13
ThAc0205

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