Increased Risk of Anemia, Neutropenia, and Thrombocytopenia in People With Human Immunodeficiency Virus and Well-Controlled Viral Replication

• Published in: The Journal of infectious diseases 2019-10, Vol.220 (11), p.1834-1842
• Main Authors: Akdag, Delal, Knudsen, Andreas Dehlbæk, Thudium, Rebekka Faber, Kirkegaard-Klitbo, Ditte Marie, Nielsen, Chivit, Brown, Peter, Afzal, Shoaib, Nordestgaard, Børge G, Lundgren, Jens, Nielsen, Susanne Dam
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anemia; Anemia - epidemiology; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; C-reactive protein; Chronic infection; Cytopenia; Denmark - epidemiology; Female; Hematology; Hepatitis; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infections; Longitudinal Studies; Lymphopenia; Lymphopenia - epidemiology; Male; Middle Aged; Neutropenia; Neutropenia - epidemiology; Population studies; Prevalence; Replication; Risk Assessment; Risk factors; Sustained Virologic Response; Thrombocytopenia; Thrombocytopenia - epidemiology; Young Adult
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiz394

Abstract Background Prior to the introduction of combination antiretroviral therapy (cART), cytopenias were common in people with human immunodeficiency virus (PWH), but it is unknown if well-controlled HIV infection is a risk factor for cytopenia. In this study we aimed to determine if HIV infection is an independent risk factor for anemia, neutropenia, lymphocytopenia, and thrombocytopenia. Methods PWH with undetectable viral replication and absence of chronic hepatitis infection (n = 796) were recruited from the Copenhagen Comorbidity in HIV Infection (COCOMO) study and matched uninfected controls from the Copenhagen General Population Study (n = 2388). Hematology was analyzed in venous blood samples. Logistic regression analyses adjusted for age, sex, ethnicity, smoking status, alcohol, and high-sensitivity C-reactive protein were performed to determine possible associations between HIV and cytopenias. Results PWH had a higher prevalence of anemia (6.9% vs 3.4%, P < .001), neutropenia (1.3% vs 0.2%, P < .001), and thrombocytopenia (5.5% vs 2.7%, P < .001) compared with uninfected controls. HIV was independently associated with anemia-adjusted odds ratio (aOR) of 2.0 (95% confidence interval [CI], 1.4–3.0); neutropenia aOR, 6.3 (95% CI, 2.0–19.6); and thrombocytopenia aOR, 2.7 (95% CI, 1.8–4.2). No association was found between HIV and lymphocytopenia. Conclusions Cytopenia is rare in people with well-controlled HIV, but HIV remains a risk factor for anemia, neutropenia, and thrombocytopenia and requires ongoing attention and monitoring.