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HIV Linked to Higher Odds of Anemia, Neutropenia, and Thrombocytopenia
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
A nationwide comparison of people with and without HIV in Denmark determined that well-controlled HIV infection independently boosted odds of 3 blood-cell deficiencies--anemia, neutropenia, and thrombocytopenia [1]. The researchers warned that these deficits, though infrequent in the study group, remain a risk in HIV populations and "require ongoing attention and monitoring."
University of Copenhagen researchers noted that combination antiretroviral therapy (cART) cuts prevalence, incidence, and severity of anemia, neutropenia, lymphocytopenia, and thrombocytopenia (low levels of red blood cells, white blood cells, lymphocytes, and platelets) [2]. But their current prevalence and HIV-associated risk remain poorly understood.
The Copenhagen team conducted this case-control study to compare prevalence of these 4 blood-cell shortfalls in people with an undetectable viral load versus uninfected people matched to the HIV group by age and sex. HIV-positive participants came from the Copenhagen Comorbidity in HIV (COCOMO) study and matched uninfected people came from the Copenhagen General Population Study. Researchers collected and analyzed blood samples using the same lab and equipment for the HIV-positive and negative groups. They used multivariable logistic regression to assess the impact of HIV and other factors on blood-cell deficiencies.
The analysis included 796 people with HIV and 2388 HIV-negative controls. Both groups had a median age around 50, and about 85% were men. The HIV group had a significantly higher proportion with non-European ethnicity (15.3% versus 3.9%, P < 0.0001) and a significantly lower proportion of never-smokers (32.8% versus 50.1%, P < 0.0001). Both groups drank a median 84 g of alcohol weekly. Only 7% of the HIV group had a CD4 count below 350, and 79% had a count above 500. Median time since HIV diagnosis stood at 13.7 years. All but 10 people with HIV currently took cART. No one with HIV had a detectable viral load, and no one had chronic hepatitis.
People with HIV had significantly higher proportions with 3 blood-cell deficiencies than the non-HIV group: anemia (6.9% versus 3.4%, P < 0.0001), neutropenia (1.3% versus 0.2%, P < 0.0002), and thrombocytopenia (5.5% versus 2.7%, P = 0.0001). The HIV group had a nonsignificantly higher prevalence of lymphocytopenia (2.4% versus 1.6%, P = 0.1687).
Regression analysis adjusted for HIV infection, age, sex, ethnicity, smoking, and alcohol use determined that HIV independently boosted odds of anemia, neutropenia, and thrombocytopenia at the following adjusted odds ratios (aOR) (and 95% confidence intervals):
HIV association with blood-cell deficiencies:
-- Anemia: aOR 2.0 (1.4 to 3.0), P = 0.0003
-- Neutropenia: aOR 6.3 (2.0 to 19.6), P = 0.0014
-- Thrombocytopenia: aOR 2.7 (1.8 to 4.2), P < 0.0001
Other variables that boosted odds of a blood-cell deficiencies were older age (for anemia, lymphocytopenia, and thrombocytopenia) and more weekly alcohol (trends for anemia and lymphocytopenia).
The Copenhagen team concluded that blood-cell deficits remain more prevalent with HIV, even in people without a detectable viral load or chronic hepatitis. Although absolute prevalence of these conditions was low, the researchers cautioned that "the clinical implications of increased risk of anemia, neutropenia, and thrombocytopenia are unknown."
References
1. Akdag D, Dehlbaek Knudsen A, Faber et al. Haematological manifestations in virologically-suppressed people living with HIV. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P210.
2. O'Connor J, Vjecha MJ, Phillips AN, et al. Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per muL: secondary outcome results from a randomised controlled trial. Lancet HIV. 2017;4:e105-e112.
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