Prevalence and factors associated with moderate-to-severe anaemia among virally suppressed people with HIV at a tertiary hospital in Zambia

Abstract

Objective Anaemia is associated with an increased risk of disease progression and all-cause mortality among HIV-infected individuals, regardless of the type of anaemia, but the magnitude of the risk is greater with more severe forms of anaemia. Although anaemia PLWH has been extensively studied, the focus has primarily been on its prevalence and association with disease progression in untreated or poorly controlled HIV cases. This study aimed to investigate the prevalence, and factors associated with moderate-to-severe anaemia among virally suppressed HIV patients at a tertiary hospital in Zambia. Methods We conducted a cross-sectional study of ART-treated PLWH for at least 6 months at Livingstone University Teaching Hospital (LUTH). Sociodemographic, clinical, and laboratory were the data collected. The primary outcome moderate to severe anaemia was defined as follows; moderate anemia as haemaoglobin levels between 8.0–10.9 g/ and severe anemia as haemoglobin levels less than 8.0 g/dL according to the WHO classification. Logistic regression was performed to identify factors associated with moderate-to-severe anaemia. Results Among 823 participants with viral suppression, the overall prevalence of anaemia and moderate-to-severe anaemia was 29.4% (n = 242; 95% confidence interval (CI): 26.3–32.6) and 14.2% (n = 117, 95% CI: 11.7–18), respectively. In the adjusted logistic regression analysis, women had higher odds of moderate to severe anaemia compared to men (AOR 2.618, 95% CI 1.182–5.799). Lymphocyte count (AOR 0.525, 95% CI 0.31–0.90) and higher BMI (AOR 1.0671, 95% CI 1.01–1.13) were also significant factors. Microcytosis (AOR 49.79, 95% CI 12.95–191.49) and normocytosis (AOR 4.38, 95% CI 1.22–15.75) were strongly associated with higher odds compared to macrocytosis. NNRTI treatment was associated with higher odds of anaemia compared to INSTI treatment (AOR 5.231, 95% CI 1.04–26.33). Traditional risk factors for anaemia like CD4+ count and tuberculosis infection were not significant. Conclusion We found a higher prevalence of anaemia and moderate-to-severe anaemia in virally suppressed PLWH, suggesting factors beyond HIV contribute to the persistence of anaemia in this cohort. Women, lower lymphocyte count, higher BMI, low mean corpuscular volume (microcytosis) indicative of microcytic anaemia, and NNRTI-based ART regimens were independently associated with moderate-to-severe anaemia. Further research is warranted to explain the underlying mechanisms and optimize clinical management to improve outcomes among virally suppressed PLWH.