Document Detail


Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group.
MedLine Citation:
PMID:  10371175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 14 g/dl for men and 12 g/dl for women; mild anaemia was 8-14 g/dl for men and 8-12 g/dl for women; severe anaemia was defined as less than 8 g/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 1 g/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.
Authors:
A Mocroft; O Kirk; S E Barton; M Dietrich; R Proenca; R Colebunders; C Pradier; A dArminio Monforte; B Ledergerber; J D Lundgren
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  13     ISSN:  0269-9370     ISO Abbreviation:  AIDS     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-09-02     Completed Date:  1999-09-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  943-50     Citation Subset:  IM; X    
Affiliation:
Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anemia / etiology*
CD4 Lymphocyte Count
Cohort Studies
Disease Progression
Europe
Female
HIV / physiology
HIV Infections / blood,  complications*,  mortality*,  virology
Hemoglobins / analysis*
Humans
Male
Middle Aged
Prognosis
Proportional Hazards Models
Prospective Studies
Viral Load
Chemical
Reg. No./Substance:
0/Hemoglobins

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