Impaired Hematological Status Increases the Risk of Mortality among HIV-Infected Adults Initiating Antiretroviral Therapy in Tanzania

• Published in: The Journal of nutrition 2020-09, Vol.150 (9), p.2375-2382
• Main Authors: Noor, Ramadhani A, Abioye, Ajibola I, Hertzmark, Ellen, Darling, Anne M, Aboud, Said, Mugusi, Ferdinand M, Sudfeld, Christopher R, Spiegelman, Donna, Fawzi, Wafaie W
• Format: Article
• Language: English
• Subjects: Adult; Adults; Anemia; Anemia - blood; Anemia - complications; anemia of chronic diseases; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Cohort Studies; Etiology; Female; Ferritin; Health risks; Hematology; Hemoglobin; Hepcidin; Highly active antiretroviral therapy; HIV; HIV Infections - blood; HIV Infections - complications; HIV Infections - epidemiology; HIV Infections - mortality; Human immunodeficiency virus; Humans; inflammation; Iron; iron deficiency; Male; Middle Aged; Morbidity; Mortality; Nutrient deficiency; Nutrition and Disease; Risk; Risk Factors; Statistical models; Supplements; Tanzania - epidemiology; Weight loss
• ISSN: 0022-3166; 1541-6100
• DOI: 10.1093/jn/nxaa172

Hematological status may predict HIV disease progression and mortality among adults initiating highly active antiretroviral therapy (HAART). We aimed to examine the relation of anemia and iron status at HAART initiation with survival and morbidity outcomes. We conducted a case-cohort study of 570 HIV-infected adults initiating HAART who were enrolled in a trial of multivitamins in Tanzania. Hemoglobin, serum ferritin, and hepcidin concentrations were assessed at HAART initiation and participants were followed up monthly. We adjusted serum ferritin for inflammation using a regression correction method to characterize hematological status. Cox proportional hazards models were used to estimate HRs for mortality and incident clinical outcomes. We found an 83% prevalence of anemia, 15% prevalence of iron deficiency anemia, and 66% prevalence of anemia of chronic diseases (ACD). The prevalence of elevated iron was 33% and 19% had iron deficiency (ID). After multivariate adjustment, severe anemia (HR: 2.57; 95% CI: 1.49, 4.45) and ACD (HR: 4.71; 95% CI: 2.91, 7.62) were associated with increased risk of mortality as compared with nonanemic participants. In addition, both ID (HR: 2.65; 95% CI: 1.08, 7.78) and elevated iron (HR: 2.83; 95% CI: 2.10, 3.82) were associated with increased risk of mortality as compared with normal iron concentrations. Severe anemia and elevated iron concentrations were associated with incident wasting and >10% weight loss (P values