Anemia in HIV/AIDS Patients on Antiretroviral Treatment at Ayder Specialized Hospital, Mekele, Ethiopia: A Case-Control Study

Abstract

Background

Human immunodeficiency virus and anemia are the major public health problems in Sub-Sahara Africa. Untreated anemia is associated with rapid progression and poor prognosis of the disease in HIV. This study was aimed at determining the magnitude, severity and associated factors of anemia among HIV infected patients taking zidovudine and tenofovir-containing first-line HAART in Ayder Comprehensive Specialized Hospital, Mekele, Ethiopia.

Methods

A case-control study was conducted from February to August 2019 using both convenient and quota sampling methods. Anemia is defined as hemoglobin value below 13 g/dl for male and below 12 g/dl for female. Sociodemographic and clinical characteristics were assessed using a structured questionnaire, medical records, electronic weighing scale, adult height board, automated hematology analyzer (Sysmex XT-4000i), and Becton Dickinson’s FACS caliber flow cytometer. Descriptive statistics, tables, graphs, Student’s t-test and l logistic regression were used to analyze the data.

Results

About one-third (33.5%) of study participants were found to be anemic (ZDV: 20.3%; TDF: 13.2%, and p<0.05). Among these anemic cases, the majority was found to have mild, and the remaining was moderate types. The most common form was normocytic-normochromic anemia (46.5%). Cotrimoxazole prophylaxis, poor adherence, advanced AIDS stage at baseline and underweight at baseline were the factors associated with anemia in patients taking zidovudine-containing regimen (p<0.05). Advanced stage at baseline, cotrimoxazole prophylaxis, poor adherence status and lack of regular income were significantly associated with anemia in patients taking tenofovir-containing regimen (p<0.05).

Conclusion

We find that the prevalence of anemia was significantly higher among patients taking ZDV-containing regimen. But different risk factors for anemia had been identified among ZDV-containing regimen, showing that appropriate follow-up, nutritional supplementation, continuous evaluation of patients on cotrimoxazole intake can reduce the risks of anemia in both types of regimens.

Keywords:

• HIV/AIDS
• tenofovir
• zidovudine
• anemia
• Ethiopia

Acknowledgments

The authors would like to express sincere gratitude to the staff of ART clinic in Ayder comprehensive specialized hospital for their support and assistance in the provision of medical records and data collection processes. We also thank Addis Ababa University for sponsoring the research project.

Abbreviations

AIDS, acquired immunodeficiency syndrome; AOR, adjusted odds ratio; ART, antiretroviral therapy; BMI, body mass index; CBC, complete blood count; CD4, cluster of differentiation 4; CPT, cotrimoxazole prophylaxis therapy; COR, crude odds ratio; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; OI, opportunistic infections; SSA, Sub-Sahara Africa; TDF, tenofovir disoproxil fumarate; ZDV, zidovudine.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Approval and Consent to Participate

The study was conducted after an ethical letter was obtained from the Research and Ethical Review Committee of the Department of Medical Physiology, Addis Ababa University, Ethiopia. The proposal was further evaluated in light of the ethical standards, originality and feasibility. The approval letter was obtained with ethical approval reference number phy/37/2019. The proposal was further evaluated by the Health Research Ethical Review Committee (HRERC) at Mekele University and approved with the expedited approval reference ERC 1325/2019. The data were collected after written informed consent was obtained from the study subjects. Codes were used and unauthorized persons didn’t have access to the data to keep confidentiality. This study was conducted in accordance with the Declaration of Helsinki.

Publication Consent

Not applicable.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed on the journal to which the article will be submitted; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This study was funded by Addis Ababa University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.