Anaemia and zidovudine‐containing antiretroviral therapy in paediatric antiretroviral programmes in the IeDEA Paediatric West African Database to evaluate AIDS

Introduction There is a risk of anaemia among HIV‐infected children on antiretroviral therapy (ART) containing zidovudine (ZDV) recommended in first‐line regimens in the WHO guidelines. We estimated the risk of severe anaemia after initiation of a ZDV‐containing regimen in HIV‐infected children incl...

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Published in:	Journal of the International AIDS Society Vol. 16; no. 1; pp. 18024 - n/a
Main Authors:	Renner, Lorna A, Dicko, Fatoumata, Kouéta, Fla, Malateste, Karen, Gueye, Ramatoulaye D, Aka, Edmond, Eboua, Tanoh K, Azondékon, Alain, Okomo, Uduok, Touré, Pety, Ekouévi, Didier, Leroy, Valeriane
Format:	Journal Article
Language:	English
Published:	Switzerland International AIDS Society 01-01-2013 John Wiley & Sons, Inc
Subjects:	Acquired immune deficiency syndrome adverse reactions Africa, Western - epidemiology Age AIDS Analysis Anemia Anemia - chemically induced Anemia - epidemiology Animals Anti-HIV Agents - adverse effects Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs antiretroviral therapy Antiretroviral Therapy, Highly Active - adverse effects Antiretroviral Therapy, Highly Active - methods Antiviral agents Care and treatment Child Child, Preschool Children Cohort analysis cohort studies Collaboration Complications and side effects Demographic aspects Diagnosis Dosage and administration Drug therapy Female Health aspects Hemoglobin HIV HIV infection HIV infection in children HIV Infections - complications HIV Infections - drug therapy Human immunodeficiency virus Humans Immune system Infections Internet Male Malnutrition Methods Mortality Pediatrics Retrospective Studies Risk factors Variables West Africa Zidovudine Zidovudine - adverse effects Zidovudine - therapeutic use Africa, Western Africa Ghana France United States > US Senegal Mali West Africa South Africa Uganda Kenya Southern Africa India cohort studies children HIV infection West Africa adverse reactions antiretroviral therapy
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Summary:	Introduction There is a risk of anaemia among HIV‐infected children on antiretroviral therapy (ART) containing zidovudine (ZDV) recommended in first‐line regimens in the WHO guidelines. We estimated the risk of severe anaemia after initiation of a ZDV‐containing regimen in HIV‐infected children included in the IeDEA West African database. Methods Standardized collection of data from HIV‐infected children (positive PCR<18 months or positive serology ≥18 months) followed up in HIV programmes was included in the regional IeDEA West Africa collaboration. Ten clinical centres from seven countries contributed (Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal) to this collection. Inclusion criteria were age <16 years and starting ART. We explored the data quality of haemoglobin documentation over time and the incidence and predictors of severe anaemia (Hb<7g/dL) per 100 child‐years of follow‐up over the duration of first‐line antiretroviral therapy. Results As of December 2009, among the 2933 children included in the collaboration, 45% were girls, median age was five years; median CD4 cell percentage was 13%; median weight‐for‐age z‐score was −2.7; and 1772 (60.4%) had a first‐line ZDV‐containing regimen. At baseline, 70% of the children with a first‐line ZDV‐containing regimen had a haemoglobin measure available versus 76% in those not on ZDV (p≤0.01): the prevalence of severe anaemia was 3.0% (n=38) in the ZDV group versus 10.2% (n=89) in those without (p<0. 01). Over the first‐line follow‐up, 58.9% of the children had ≥1 measure of haemoglobin available in those exposed to ZDV versus 60.4% of those not (p=0.45). Severe anaemia occurred in 92 children with an incidence of 2.47 per 100 child‐years of follow‐up in those on a ZDV‐containing regimen versus 4.25 in those not (p≤0.01). Adjusted for age at ART initiation and first‐line regimen, a weight‐for‐age z‐score ≤−3 was a strong predictor associated with a 5.59 times risk of severe anaemia (p<0.01). Conclusions Severe anaemia is frequent at baseline and guides the first‐line ART prescription, but its incidence seems rare among children on ART. Severe malnutrition at baseline is a strong predictor for development of severe anaemia, and interventions to address this should form an integral component of clinical care.
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ISSN:	1758-2652 1758-2652
DOI:	10.7448/IAS.16.1.18024