Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study
Open Access
- 9 March 2020
- Vol. 10 (3), e031487
- https://doi.org/10.1136/bmjopen-2019-031487
Abstract
Objective Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemoglobin change with core ART classes in the current ART era. Design Retrospective cohort study. Setting USA-based prospective clinical cohort of PLWH aged 18 and above receiving care at eight sites between January 2010 and March 2018. Participants 16 505 PLWH were included in this study. Main outcome measures Anaemia risk and haemoglobin change were estimated among PLWH for person-time on a protease inhibitor (PI) or an integrase strand transfer inhibitor (INSTI)-based regimen, relative to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based reference. We also examined PLWH on regimens containing multiple core classes. Cox proportional hazards regression analyses were conducted to measure the associations between time-updated ART classes and incident anaemia or severe anaemia. Linear mixed effects models were used to examine the relationships between ART classes and haemoglobin change. Results During a median of 4.9 years of follow-up, 1040 developed anaemia and 488 developed severe anaemia. Compared with NNRTI use, INSTI-based regimens were associated with an increased risk of anaemia (adjusted HR (aHR) 1.26, 95% CI 1.00 to 1.58) and severe anaemia (aHR 1.51, 95% CI 1.07 to 2.11) and a decrease in haemoglobin level. Time on multiple core classes was also associated with increased anaemia risk (aHR 1.39, 95% CI 1.13 to 1.70), while no associations were found for PI use. Conclusion These findings suggest INSTI use may increase the risk of anaemia. If confirmed, screening for anaemia development in users of INSTIs may be beneficial. Further research into the underlying mechanisms is warranted.Keywords
Funding Information
- National Heart, Lung and Blood Institute (R01HL126538-01A1, T32HL007828)
- National Institute of Allergy and Infectious Diseases (P30 32 AI027757, P30 AI50410, P30 AI094189 and P30)
- National Institutes of Health (R24 AI067039)
This publication has 32 references indexed in Scilit:
- Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in NigeriaBMC Infectious Diseases, 2013
- Short‐term risk of anaemia following initiation of combination antiretroviral treatment in HIV‐infected patients in countries in sub‐Saharan Africa, Asia‐Pacific, and central and South AmericaJournal of the International AIDS Society, 2012
- Haemoglobin and Anaemia in the Smart StudyAntiviral Therapy, 2010
- Cohort profile: the Centers for AIDS Research Network of Integrated Clinical SystemsInternational Journal of Epidemiology, 2008
- Anemia in HIV Infection: Clinical Impact and Evidence-Based Management StrategiesClinical Infectious Diseases, 2004
- Prevalence and Cumulative Incidence of and Risk Factors for Anemia in a Multicenter Cohort Study of Human Immunodeficiency Virus–Infected and –Uninfected WomenClinical Infectious Diseases, 2002
- A Clinically Prognostic Scoring System for Patients Receiving Highly Active Antiretroviral Therapy: Results from the EuroSIDA StudyThe Journal of Infectious Diseases, 2002
- Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across EuropeAIDS, 1999
- The need for randomization in the study of intended effectsStatistics in Medicine, 1983