A. Mocroft et al., Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe, AIDS, 13(8), 1999, pp. 943-950
Objectives: To describe changes in haemoglobin over time and to determine t
he 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 observation
al, 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 ma
les and females. Linear regression techniques were used to estimate the ann
ual change in haemoglobin; standard survival techniques were used to descri
be disease progression and risk of death.
Results: At recruitment, to the study, 40.4% had normal levels of haemoglob
in, 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-upda
ted 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% dr
op 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 patien
ts with similar CD4 lymphocyte counts and viral load, the latest value of h
aemoglobin was a strong independent prognostic marker for death. (C) 1999 L
ippincott Williams & Wilkins.