Determinants for zidovudine-induced anemia in HIV adult patients: A Thai multicenter study

Abstract

Objectives: This study was aimed to analyze the prevalence of zidovudine (AZT)-induced anemia, severity and determinants for the anemia in Thai human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Materials and Methods: A cross-sectional, multicenter study was carried out in HIV/AIDS adult out-patients who were taking AZT as part of the highly active antiretroviral therapy regimens, met relevant eligibility criteria and attended the eight antiretroviral clinics of community hospitals in Chumphon Province during January 2010-May 2012. Data on the prevalence and anemia characteristics were collected and analyzed. A binary logistic regression was performed to determine relevant factors with a significance level (α) of 0.05. Results: A total of 303 patients were included and nearly 71.6% of these started AZT + lamivudine + nevirapine as the primary regimen. Nearly half were male (48.8%) and the mean age was 39.5 years (standard deviation [SD] =8.6). Of 303 patients, 34 developed anemia that clearly started from 4 to 24 weeks after AZT-based therapy; the prevalence rate was 11.2%. With the AZT-induced anemia, patients mostly had the baseline CD4 count lower than 200 cells/mm 3 ( 64.7%), baseline body mass index (BMI) >18.5 kg/m 2 ( 61.8%) and baseline hemoglobin (Hb) in the range of 8.0-9.5 g/dL (85.3%); the mean Hb change from the baseline was 4.5 g/dL (SD = 3.2). The severity of anemia was mainly classified as grade 1 (55.9%) or 4 (32.4%). Four risk factors, i.e. baseline CD4 levels, Hb, BMI and duration of AZT use, significantly attributed to the anemia (P = 0.018, 0.004, 0.009 and 0.002, respectively). The risk of anemia could be predicted by 33.3% using the equation: Logit P anemia = 6.186 + 1.666 × Baseline CD4 level-0.501 × Baseline Hb-0.225 × Baseline BMI + 2.338 × Duration of AZT therapy. Conclusion: HIV patients using AZT may experience mild-to-severe anemia with salient features. Four determining factors for the anemia should be closely monitored by pharmacists or health care professionals before altering the regimen