[MOL] Series... [01127] Medicine On Line

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The EuroSIDA Study

To further assess a potential relationship between anemia, immunologic damage during HIV infection, and clinical manifestations, the EuroSIDA study was performed.[25] In this survey of anemia prevalence, CD4 lymphocyte counts and hemoglobin levels were available for 6725 patients at the time of recruitment. Approximately 40% of patients were found to have normal hemoglobin levels, that is, greater than 14 g/dL for men and greater than 12 g/dL for women. A total of 1.4% of the patients were found to have severe anemia, with a hemoglobin level less than 8 g/dL, and the remaining 58.2% of the patients were found to have a mild anemia with values between 8 g/dL and normal. At 12 months after enrollment, only 3% of those patients with a normal hemoglobin level had died, compared with 16% with mild anemia and 41% of the patients with an hemoglobin level less than 8 g/dL. The same relationship with anemia was found after stratification for the absolute number of CD4 cells, suggesting that the hemoglobin level is an independent prognostic marker. The HIV viral load was also assessed in these patients. In the adjusted analysis, a decrease in hemoglobin level of 1 g/dL increased the relative hazard of dying by 1.57, which made this marker at least as important a factor as the other two prognostic markers in evaluating the risk of death.

In Dr. Moore's experience at Hopkins, patients with a hemoglobin level less than 10 g/dL had an almost 3-fold relative risk of dying compared with those having higher hemoglobin levels. Again, this effect was seen as an independent prognostic factor, independent of the CD4 cell count and viral load.[26] Thus, these observations do not prove causality but suggest that anemia may be an independent prognostic factor for clinical outcome in HIV patients.[26,27] What happens when the hemoglobin levels improve in HIV patients? Are outcomes improved? In the survey by Sullivan and colleagues, 32,000 HIV-infected patients were compared, evaluating patients who had been treated for anemia vs those who had not received a specific treatment.[25] Moore and coworkers evaluated their database for similar outcomes,[24,28] and they found a similar outcome in patients with clinical correction of their anemia and in patients who had never developed anemia in the course of their HIV infection. Prospective trials are needed in the future to better assess the impact of management of anemia in the AIDS population and its impact on quality of life and treatment outcome.

Warmly, lillian
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