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Anemia Decreases Survival in Women With HIV Infection

Anemia Decreases Survival in Women With HIV Infection

ORLANDO—A multicenter, prospective study has shown that anemia is an
independent risk factor predicting decreased survival in HIV-infected women and
that highly active antiretroviral therapy (HAART) helps resolve anemia in this
population group.

Alexandra M. Levine, MD, chief, Division of Hematology, and medical
director, USC/Norris Cancer Hospital, reported the results at a poster session
of the 43rd Annual Meeting of the American Society of Hematology (abstract
2091).

Independent Risk Factor

"When you look at all the known risk factors for decreased survival—such
as low CD4 cell counts, high HIV RNA levels, or history of clinical AIDS—then
add anemia into that mix, it turns out that anemia as an independent risk
factor is equally important," Dr. Levine said (see Table).

Study participants included 2,054 HIV-positive women and 568 HIV-negative
controls in the National Institutes of Health-sponsored Women’s Interagency
HIV Study. Anemia was defined as a hemoglobin level of less than 12
g/dL. Patients were followed for 4 years, from 1994 to 1998.

More than half (56%) of the HIV-positive subjects were black. Overall, in
the United States, more black women than white women are HIV positive.

Dr. Levine noted that HIV-infected women are statistically more likely to be
anemic than HIV-infected men and that regardless of HIV status, black women are
more likely than white women to suffer from anemia. The new study found that
HIV-positive women are significantly more likely than HIV-negative women to be
anemic (P < .001). On multivariate analysis, factors associated with anemia
in HIV-infected women in this study were self-reported history of clinical AIDS
condition, CD4+ cell counts less than 200/µL, serum HIV-RNA counts greater
than 50,000 copies/mL, current use of zidovudine (AZT, Retrovir), mean
corpuscular volume (MCV) less than 80 fL, and African-American ethnicity.

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