Prevalence and correlates of anemia among HIV infected patients on highly active anti-retroviral therapy at Zewditu Memorial Hospital, Ethiopia

Muluken Assefa, Woldaregay Erku Abegaz, Aster Shewamare, Girmay Medhin, Mulugeta Belay

Ethiopia is one of the most seriously HIV affected countries in Sub-Saharan Africa. Anemia is a known predictor of disease progression and death among HIV infected patients. In this study, we investigated the magnitude and correlates of anemia among HIV infected patients receiving HAART at a referral hospital in Ethiopia. A retrospective cohort study was conducted from November 2011 to February 2012 in Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Records of 1061 patients on HAART were selected using simple random sampling technique. Socio-demographic and clinical characteristics of the study patients were collected using standardized data extraction instrument. Data were analyzed using STATA version 11.0. Odds ratios with 95% confidence intervals were used to quantify the strength of association between anemia and its potential predictors. The prevalence of anemia at baseline was 42.9%. However, the prevalence significantly decreased to 20.9% at 6 months (p < 0.001) and to 14.3% at 12 months (p = 0.001) after HAART initiation. At baseline, male sex (AOR = 1.55; 95% CI: 1.18-2.03), clinical stage III/IV (AOR = 2.03; 95% CI: 1.45-2.83) and TB co-infection (AOR = 1.52; 95% CI: 1.08-2.13) were independently associated with the odds of being anemic. After 6 months of HAART, male sex (AOR = 1.59; 95% CI: 1.13-2.23), baseline anemia (AOR = 2.38; 95% CI: 1.71-3.33) and TDF-based HAART (AOR = 2.87; 95% CI: 1.80-4.60) were independently associated with the odds of being anemic. Besides, anemia was independently associated with older age at 6 months. After 12 months of HAART, baseline anemia (AOR = 2.01; 95% CI: 1.36-2.97), age group 25-34 years (AOR = 5.92; 95% CI: 1.39-25.15), age group 45-54 years (AOR = 4.78; 95% CI: 1.07-21.36), CD4 count below 200 cells/mm(3) (AOR = 2.15; 95% CI: 1.21-3.82) and 200-350 cells/mm(3) (AOR = 1.91; 95% CI: 1.13-3.25) were independently associated with the odds of being anemic. Although a remarkable reduction in the prevalence of anemia was observed following initiation of HAART, a significant proportion of HIV patients remained anemic after 12 months of HAART suggesting the need for routine screening and proper treatment of anemia to mitigate its adverse effects.