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Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation
Clinical Infectious Diseases
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.
Shivakoti R, Yang WT, Gupte N, Berendes S, Rose A, Cardoso SW, Mwelase N, Kanyama C, Pillay S, Samaneka W, Riviere C, Sugandhavesa P, Santos B, Poongulali S, Tripathy S, Bollinger RC, Currier JS, Tang AM, Semba RD, Christian P, Campbell TB, Gupta A; NWCS 319 and PEARLS Study Team. Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation. Clin Infect Dis. 2015 Mar 31. doi: 10.1093/cid/civ265.