TY - JOUR
T1 - Concurrent anemia and elevated C-reactive protein predicts HIV clinical treatment failure, including tuberculosis, after antiretroviral therapy initiation
AU - Shivakoti, Rupak
AU - Yang, Wei Teng
AU - Gupte, Nikhil
AU - Berendes, Sima
AU - Rosa, Alberto La
AU - Cardoso, Sandra W.
AU - Mwelase, Noluthando
AU - Kanyama, Cecilia
AU - Pillay, Sandy
AU - Samaneka, Wadzanai
AU - Riviere, Cynthia
AU - Sugandhavesa, Patcharaphan
AU - Santos, Brento
AU - Poongulali, Selvamuthu
AU - Tripathy, Srikanth
AU - Bollinger, Robert C.
AU - Currier, Judith S.
AU - Tang, Alice M.
AU - Semba, Richard D.
AU - Christian, Parul
AU - Campbell, Thomas B.
AU - Gupta, Amita
N1 - Publisher Copyright:
© 2015 The Author 2015.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Background: Anemia is a known risk factor for clinical failure following antiretroviral therapy (ART). Notably, anemia and inflammation are interrelated, and recent studies have associated elevated C-reactive protein (CRP), an inflammation marker, with adverse human immunodeficiency virus (HIV) treatment outcomes, yet their joint effect is not known. The objective of this study was to assess prevalence and risk factors of anemia in HIV infection and to determine whether anemia and elevated CRP jointly predict clinical failure post-ART. Methods: A case-cohort study (N = 470 [236 cases, 234 controls]) was nested within a multinational randomized trial of ART efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings [PEARLS]). Cases were incident World Health Organization stage 3, 4, or death by 96 weeks of ART treatment (clinical failure). Multivariable logistic regression was used to determine risk factors for pre-ART (baseline) anemia (females: hemoglobin <12.0 g/dL; males: hemoglobin <13.0 g/dL). Association of anemia as well as concurrent baseline anemia and inflammation (CRP ≥10 mg/L) with clinical failure were assessed using multivariable Cox models. Results: Baseline anemia prevalence was 51% with 15% prevalence of concurrent anemia and inflammation. In analysis of clinical failure, multivariate-adjusted hazard ratios were 6.41 (95% confidence interval [CI], 2.82-14.57) for concurrent anemia and inflammation, 0.77 (95% CI,. 37-1.58) for anemia without inflammation, and 0.45 (95% CI,. 11-1.80) for inflammation without anemia compared to those without anemia and inflammation. Conclusions: ART-naive, HIV-infected individuals with concurrent anemia and inflammation are at particularly high risk of failing treatment, and understanding the pathogenesis could lead to new interventions. Reducing inflammation and anemia will likely improve HIV disease outcomes. Alternatively, concurrent anemia and inflammation could represent individuals with occult opportunistic infections in need of additional screening.
AB - Background: Anemia is a known risk factor for clinical failure following antiretroviral therapy (ART). Notably, anemia and inflammation are interrelated, and recent studies have associated elevated C-reactive protein (CRP), an inflammation marker, with adverse human immunodeficiency virus (HIV) treatment outcomes, yet their joint effect is not known. The objective of this study was to assess prevalence and risk factors of anemia in HIV infection and to determine whether anemia and elevated CRP jointly predict clinical failure post-ART. Methods: A case-cohort study (N = 470 [236 cases, 234 controls]) was nested within a multinational randomized trial of ART efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings [PEARLS]). Cases were incident World Health Organization stage 3, 4, or death by 96 weeks of ART treatment (clinical failure). Multivariable logistic regression was used to determine risk factors for pre-ART (baseline) anemia (females: hemoglobin <12.0 g/dL; males: hemoglobin <13.0 g/dL). Association of anemia as well as concurrent baseline anemia and inflammation (CRP ≥10 mg/L) with clinical failure were assessed using multivariable Cox models. Results: Baseline anemia prevalence was 51% with 15% prevalence of concurrent anemia and inflammation. In analysis of clinical failure, multivariate-adjusted hazard ratios were 6.41 (95% confidence interval [CI], 2.82-14.57) for concurrent anemia and inflammation, 0.77 (95% CI,. 37-1.58) for anemia without inflammation, and 0.45 (95% CI,. 11-1.80) for inflammation without anemia compared to those without anemia and inflammation. Conclusions: ART-naive, HIV-infected individuals with concurrent anemia and inflammation are at particularly high risk of failing treatment, and understanding the pathogenesis could lead to new interventions. Reducing inflammation and anemia will likely improve HIV disease outcomes. Alternatively, concurrent anemia and inflammation could represent individuals with occult opportunistic infections in need of additional screening.
KW - CRP
KW - HIV
KW - anemia
KW - antiretroviral therapy
KW - inflammation
UR - http://www.scopus.com/inward/record.url?scp=84953863979&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84953863979&partnerID=8YFLogxK
U2 - 10.1093/cid/civ265
DO - 10.1093/cid/civ265
M3 - Article
C2 - 25828994
AN - SCOPUS:84953863979
SN - 1058-4838
VL - 61
SP - 102
EP - 110
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -