Anemia and Survival in Human Immunodeficiency Virus

Abstract

The prospective, multicenter cohort study EuroSIDA has previously reported on predictors and outcomes of anemia in patients infected with human immunodeficiency virus. In a Cox proportional-hazards model with serial measures of CD4+ cell count, plasma viral load, and degrees of anemia fitted as time-dependent variables, the relative hazard of death increased markedly for patients with anemia versus no anemia. A clinical scoring system was developed and validated for patients receiving highly active antiretroviral therapy using the most recent laboratory measures. Mild and severe anemia were independently (P<.01) associated with clinical disease progression, with a relative hazard of disease progression of 2.2 (95% confidence interval [CI], 1.6-2.9) and 7.1 (95% CI, 2.5-20.1), respectively, compared with patients with no anemia. The mechanisms underlying why hemoglobin is such a strong prognostic marker and whether correction of anemia itself results in a better prognosis remain to be determined.