Anemia in Antiretroviral Naïve HIV/AIDS Patients: A Study from Eastern India

Pande, A and Bhattacharyya, M and Pain, S and Ghosh, B and Saha, S and Ghosh, A and Banerjee, A (2012) Anemia in Antiretroviral Naïve HIV/AIDS Patients: A Study from Eastern India. [Journal (On-line/Unpaginated)]

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Background: Hematological manifestations are common throughout the course of HIV infection. Impact of anemia is the most significant among them. The present study was undertaken to evaluate the etiologies underlying anemia in HIV/AIDS. Methods This was a non randomized cross sectional observational study conducted in a tertiary care hospital of India over a period of 2 years. One hundred and fifty HIV patients were screened. Thorough clinical and laboratory evaluation was done in 50 randomly selected anemic cases. Results: Proper etiological diagnosis could be reached in 46 patients. Among them correlation between Hb% and CD4 count was statistically insignificant (p = 0.074, r = 0.47) whereas it was significant with absolute lymphocyte and CD4 count (p = 0.006, r = 0.41). There was better correlation of bone marrow iron status with percent saturation of transferrin (p = 0.003, r = 0.54) than with serum ferritin (p = 0.055, r = 0.09). Bone marrow iron status did not have any relationship with CD4 count. Anemia of chronic disease was the commonest etiology (37%) followed by HIV related myelodysplastic syndrome (31%), iron deficiency anemia (13%), bone marrow suppression due to direct involvement by some infective process (7%). Aplastic anemia, multiple myeloma, Hodgkin’s disease, pure red cell aplasia, hemophagocytic lymphohistiocytosis and vitamin B12 deficiency were detected in one case (2%) each. Conclusions: Etiologies of anemia in HIV/AIDS are multifactorial with anemia of chronic disease being the commonest. For screening of iron deficiency in this group, percent saturation is a better tool than serum ferritin. Absolute lymphocyte count can sometimes be used as a surrogate marker of immunological status in antiretroviral naïve HIV patients, particularly in resource poor areas.

Item Type:Journal (On-line/Unpaginated)
Keywords:HIV; AIDS; Anemia; MDS; India
Subjects:JOURNALS > Online Journal of Health and Allied Sciences
ID Code:8854
Deposited By: Kakkilaya Bevinje, Dr. Srinivas
Deposited On:04 May 2013 23:03
Last Modified:04 May 2013 23:03

References in Article

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1. Mocroft A, Kirk O, Barton SE, Dietrich M, Proenca R, Colebunders R, et al. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA study group. AIDS 1999;13(8):943-950.

2. Moore RD, Keruly JC, Chaisson RE. Anemia and survival in HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 1998;19(1):29-33.

3. Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 1998;91(1):301-308.

4. Coyle TE. Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med Clin North Am 1997;81:449–70.

5. Simpson MB, Delong N. Autoimmune hemolytic anemia in a patient with acquired immunodeficiency syndrome. Blood 1987;705:127.

6. World Health Organization. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. Geneva, Switzerland: 2001 (WHO/NHD/01.3)

7. WHO Global Database on Anaemia. Available at

8. Spivak JL, Bender BS, Quinn TC. Hematologic abnormalities in the acquired immune deficiency syndrome. Am J Med 1984;77:224.

9. Zon LI, Arkin C, Groopman JE. Haematologic manifestations of the human immune deficiency virus (HIV). Br J Haematol 1987;66:251.

10. Treacy M, Lai L, Costello C, Clark A. Peripheral blood and bone marrow abnormalities in patients with HIV-related disease. Br J Haematol 1987;65:289.

11. Zon LI, Groopman JE. Haematologic manifestations of the human immune deficiency virus (HIV). Semin Hematol 1988;25:208.

12. Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, et al. Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women’s Interagency HIV Study. J Acquir Immune Defic Syndr 2001;26:28–35.

13. Creagh T, Mildvan D. Greater prevalence of anemia in women and African Americans with HIV/AIDS in the HAART era: a study of 10,000 patients [abstract 475]. The Anemia Prevalence Study Group. In: Program and abstracts of the 40th Annual Meeting of the Infectious Diseases Society of America (Chicago). Alexandria, VA: Infectious Diseases Society of America, 2002:127.

14. Semba RD, Shah N, Klein RS, Mayer KH, Schuman P, Vlahov D. Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus–infected and –uninfected women. Clin Infect Dis 2002;34:260–266.

15. Alavi SM, Ahmadi F, Farhadi M. Correlation between Total Lymphocyte Count, Hemoglobin, Hematocrit and CD4 Count in HIV/AIDS Patients. Acta Medica Iranica 2009;47(1):1-4.

16. Stella CC, Ganser A, Hoelzer D. Defective in vitro growth of the hemopoietic progenitor cells in the acquired immunodeficiency syndrome. J Clin Invest 1987;80:286.

17. Guillemain C, George F, Courcoul M, Dhiver C, Brunet C, Spire B, et al. Monoblastic leukemia in an HIV infected patient: absence of viral expression in RNA blasts. Am J Hematol 1996;52:47-52.

18. Kaczmarski RS, Davison F, Blair E, Sutherland S, Moxham J, McManus T, et al. Detection of HIV in haemopoietic progenitors. Br J Hematol 1992;82:764-769.

19. Folks TM: Human immunodeficiency virus in bone marrow: still more questions than answers. Blood 1991;77:1625-1626.

20. Katsarou O, Terpos E, Patsouris E, Peristeris P, Viniou N, Kapsimali V, et al. Myelodysplastic features in patients with long-term HIV infection and haemophilia. Haemophilia 2001;7(1):47-52.

21. Sears DA. Anemia of chronic disease. Med Clin North Am 1992;76:567–579.

22. Bertero MT, Caligaris-Cappio F. Anemia of chronic disorders in systemic autoimmune diseases. Haematologica 1997;82:375–381.

23. Semba RD, Taha TE, Kumwenda N, Mtimavalye L, Broadhead R, Miotti PG, et al. Iron status and indicators of human immunodeficiency virus disease severity among pregnant women in Malawi. Clin Infect Dis 2001;32(10):1496-1499. Epub 2001 Apr 20.

24. Paradela A, Rivas C, Fernandez-Guerrero M, Roman A. Histopathology of bone marrow biopsy in patients with human immunodeficiency virus infection. Rev Clin Esp 1996;196:9-15.

25. Goedert JJ, Cote TR, Virgo P. Spectrum of AIDS-associated malignant disorders. Lancet 1998;351:1833-1839.

26. Fiorino AS, Atac B. Paraproteinemia, plasmacytoma,myeloma and HIV infection. Leukemia 1997;11:2150-2156.

27. Saif M W, Kevin S. Multiple myeloma and HIV infection: An association or a coincidence. The Journal of Applied Research 2005;5:318-324.

28. Dolcetti R, Boiocchi M, Gloghini A, Carbone A. Pathogenetic and histogenetic features of HIV-associated Hodgkin’s disease. Eur J Cancer 2001;37:1276-1287.

29. Grateau G, Bachmeyer C, Blanche P, Jouanne M, Tulliez M, Galland C et al. Haemophagocytic syndrome in patients infected with the human immunodeficiency virus: nine cases and a review. J Infect1997;34:219–225.

30. Tiab M, Mechinaud Lacroix F, Hamidou M, Gaillard F, Raffi F. Reactive haemophagocytic syndrome in AIDS. AIDS 1996;10:108–111.

31. Costello C. Haematological abnormalities in human immunodeficiency virus (HIV) disease. J Clin Pathol 1988;41:711–715.


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