THE THE IMPACT OF ANTIRETROVIRAL THERAPY ON HEMOGLOBIN LEVELS OF HIV/AIDS PATIENTS AT MERPATI CLINIC, WANGAYA HOSPITAL, DENPASAR, BALI, INDONESIA
Objective: Anemia is responsible for poor outcomes in HIV/AIDS patients. It’s related to disease progression, morbidity, and mortality. Antiretroviral therapy (ART) agent, zidovudine (ZDV) is also known to trigger anemia in the early initiation. However, studies found improved hemoglobin (Hb) levels of HIV/AIDS patients several months after ART routinely taken. This study aims to find the impact and correlation of ART on the hemoglobin level of HIV/AIDS patients.
Methods: A retrospective cohort study was done at Merpati Clinic, Wangaya Hospital, Denpasar-Bali, Indonesia. Data were collected from medical records and laboratory results. A total sample of 64 HIV/AIDS patients with at least 6 mo on ART was included in this study.
Results: Anemia was found in 34 (53.1%) of patients before ART initiation. After taking ART for 6 mo, we observed a significant improvement in patients’ hemoglobin levels, 48 (75%) shows increased hemoglobin levels. The paired t-test revealed a correlation between ART and Hb level (p<0.001). Fourteen (43.8%) patient taking ZDV shows no improvement, even declining of Hb level. Chi-square analysis performed with p = 0.001 to ZDV and lower or no improvement of hemoglobin level. Both results considered statistically significant (p-value less than 0.05) with a confidence interval (CI) of 95%. Relative risk (RR) of no improvement or decline in Hb level is 7 folds higher in the ZDV group than the non-ZDV group.
Conclusion: This study concludes that ART affects hemoglobin levels in HIV/AIDS patients. Zidovudine regimen is more prone to lower or no increase of Hb.
2. Gebremedhin KB, Haye TB. Factors associated with anemia among people living with HIV/AIDS taking ART in Ethiopia. Adv Hematol 2019;2:1-8.
3. Takuva S, Maskew M, Brennan AT, Sanne I, MacPhail AP, Fox MP. Anemia among HIV-infected patients initiating antiretroviral therapy in South Africa: Improvement in hemoglobin regardless of degree of immunosuppression and the initiating ART regimen. J Trop Med 2013;1-6.
4. Ferede G, Wondimeneh Y. Prevalence and related factors of anemia in HAART-naive HIV positive patients at Gondar University Hospital, Northwest Ethiopia. BMC Blood Disord 2013;13:8.
5. Meidani M, Rezaei F, Maracy MR, Avijgan M, Tayeri K. Prevalence, severity, and related factors of anemia in HIV/AIDS patients. J Res Med Sci 2012;17:138-42.
6. Panwar A, Sharma SC, Kumar S, Sharm A. A study of anemia in human immunodeficiency virus patients: Estimating the prevalence, analyzing the causative effect of nutritional deficiencies, and correlating the degree of severity with CD4 cell counts. Med J DY Patil Univ 2016;9:312-8.
7. Woldeamanuel GG, Wondimu DH. Prevalence of anemia before and after initiation of antiretroviral therapy among HIV infected patients at Black Lion Specialized Hospital, Addis Ababa, Ethiopia: a cross sectional study. BMC Hematol 2018;18:7.
8. Redig AJ, Berliner N. Pathogenesis and clinical implications of HIV-related anemia in 2013. Hematology Am Soc Hematol Educ Program 2013;1:377-81.
9. Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults. JAMA 2018;320:379-96.
10. World Health Organization. Worldwide prevalence on anaemia 1993-2005. Geneva: World Health Organization; 2008. p. 4-6.
11. Limmade Y, Fransisca L, Rodriguez Fernandez R, Bangs MJ, Rothe C. HIV treatment outcomes following antiretroviral therapy initiation and monitoring: a workplace program in Papua, Indonesia. PLoS One 2019;14:e0212432.
12. Tamir Z, Alemu J, Tsegaye A. Anemia among HIV infected individuals taking ART with and without zidovudine at Addis Ababa, Ethiopia. Ethiop J Health Sci 2018;28:73–82.
13. Johannessen A, Naman E, Gundersen SG, Bruun JN. Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania. BMC Infectious Diseases 2011;11:190.
14. Wahyuwibowo J, Harumsari S, Zulaikha ST, Suwondo A, Sofro MAU, Hadisaputro S. Age and CD4 count are dominant factors in the prediction of anaemia in Javanese HIV patients. Asia Pac J Clin Nutr 2018;27:649?54.
15. De Santis G, Brunetta D, Vilar F, Brandao R, de Albernaz Muniz R, de Lima G, et al. Hematological abnormalities in HIV-infected patients. Int J Infect Dis 2011;15:e808-11.
16. Insaniputri P, Supardi S, Andrajati R. Comparison of zidovudine combination and tenofovir combination on the effectiveness of therapy and side effects in HIV/AIDS patients in RSAL mintohardjo. Asian J Pharm Clin Res 2017;10 Suppl 5:93-6.
17. Chioma AD, Chukwuma B, Chinomnso C. Prevalence and pattern of adverse drug reactions among HIV infected patients on highly active antiretroviral therapy (HAART) in Imo State, Nigeria: a hospital based survey. J Drug Delivery Ther 2019;9 Suppl 6s:5-11.
18. Bansal R, Daryani KK, Singh AP. Pharmacovigilance study of antiretroviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome patients at the antiretroviral therapy centre, Jabalpur. Asian J Pharm Clin Res 2018;11:272-9.
19. Hiremath RN, Patil SS, Yadav AK. Nutritional status of people living with HIV/acquired immunodeficiency syndrome–a cross-sectional study. Asian J Pharm Clin Res 2018;11:456-9.
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