Anaemia is an independent predictive marker for clinical... : AIDS (original) (raw)

Clinical: Original Papers

Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe

Mocroft, Amandaa; Kirk, Oleb; Barton, Simon E.c; Dietrich, Manfredd; Proenca, Ruie; Colebunders, Robertf; Pradier, Cristiang; Monforte, Antonella d‚Arminioh; Ledergerber, Brunoi; Lundgren, Jens D.b for the EuroSIDA study group

From the aRoyal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK, the bEuroSIDA Coordinating Centre, Hvidovre Hospital, Copenhagen, Denmark, the cChelsea and Westminster Hospital, London, UK, the dBernhard-Nocht-Institut for Tropical Medicine, Hamburg, Germany, the eHospital Curry Cabral, Lisbon, Portugal, the fInstitute of Tropical Medicine, Antwerp, Belgium, the gHopital de l‚Archet, Nice, France, the hOsp. L. Sacco, Milan, Italy and the iUniversity Hospital, Zurich, Switzerland. *See Appendix for study members.

Sponsorship: The European Commission BIOMED 1 (CT94-1637) and BIOMED 2 (CT97-2713) programmes were the primary sponsor of the study. Pharmacia & UpJohn, Glaxo Wellcome, Roche and Merck also provided unrestricted grants. The participation of Swiss sites was supported by a grant from the Swiss Federal Office for Education and Science.

Requests for reprints to: Dr A Mocroft, Royal Free Centre for HIV Medicine and Dept of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, Rowland Hill St, London NW3 2PF, UK.

Received: 4 January 1999; revised: 16 February 1999; accepted: 22 February 1999.

Abstract

Objectives:

To describe changes in haemoglobin over time and to determine the joint prognostic value of the current haemoglobin, CD4 lymphocyte count and viral load among patients from across Europe.

Patients:

The analysis included 6725 patients from EuroSIDA, an observational, prospective cohort of patients with HIV from across Europe.

Methods:

Normal haemoglobin was defined as haemoglobin greater than 14g/dl for men and 12g/dl for women; mild anaemia was 8-14g/dl for men and 8-12g/dl for women; severe anaemia was defined as less than 8g/dl for both males and females. Linear regression techniques were used to estimate the annual change in haemoglobin; standard survival techniques were used to describe disease progression and risk of death.

Results:

At recruitment to the study, 40.4% had normal levels of haemoglobin, 58.2% had mild anaemia and 1.4% had severe anaemia. At 12 months after recruitment, the proportion of patients estimated to have died was 3.1% [95% confidence interval (CI) 2.3-3.9] for patients without anaemia, 15.9% for patients with mild anaemia (95% CI 14.5-17.2) and 40.8% for patients with severe anaemia (95% CI 27.9-53.6; P<0.0001). In a multivariate, time-updated Cox proportional hazards model, adjusted for demographic factors, AIDS status and each antiretroviral treatment as time-dependent covariates, a 1g/dl decrease in the latest haemoglobin level increased the hazard of death by 57% [relative hazard (RH) 1.57; 95% CI 1.41-1.75; P<0.0001], a 50% drop in the most recent CD4 lymphocyte count increased the hazard by 51% (RH 1.51; 95% CI 1.35-1.70; P<0.0001) and a log increase in the latest viral load increased the hazard by 37% (RH 1.37; 95% CI 1.15-1.63; _P_=0.0005).

Conclusions:

Severe anaemia occurred infrequently among these patients but was associated with a much faster rate of disease progression. Among patients with similar CD4 lymphocyte counts and viral load, the latest value of haemoglobin was a strong independent prognostic marker for death.