Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation

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Clinical Infectious Diseases

Background: Anemia is a known risk factor for clinical failure following antiretroviral therapy (ART). Notably, anemia and inflammation are interrelated, and recent studies have associated elevated C-reactive protein (CRP), an inflammation marker, with adverse human immunodeficiency virus (HIV) treatment outcomes, yet their joint effect is not known. The objective of this study was to assess prevalence and risk factors of anemia in HIV infection and to determine whether anemia and elevated CRP jointly predict clinical failure post-ART.


Methods: A case-cohort study (N = 470 [236 cases, 234 controls]) was nested within a multinational randomized trial of ART efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings [PEARLS]). Cases were incident World Health Organization stage 3, 4, or death by 96 weeks of ART treatment (clinical failure). Multivariable logistic regression was used to determine risk factors for pre-ART (baseline) anemia (females: hemoglobin <12.0 g/dL; males: hemoglobin <13.0 g/dL). Association of anemia as well as concurrent baseline anemia and inflammation (CRP ≥ 10 mg/L) with clinical failure were assessed using multivariable Cox models.


Shivakoti R, Yang WT, Gupte N, Berendes S, Rose A, Cardoso SW, Mwelase N, Kanyama C, Pillay S, Samaneka W, Riviere C, Sugandhavesa P, Santos B, Poongulali S, Tripathy S, Bollinger RC, Currier JS, Tang AM, Semba RD, Christian P, Campbell TB, Gupta A; NWCS 319 and PEARLS Study Team. Concurrent anemia and elevated CRP predicts HIV clinical treatment failure, including TB, post-antiretroviral therapy initiation. Clin Infect Dis. 2015 Mar 31. doi: 10.1093/cid/civ265.
  • Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre
  • Asociacion Civil Impacta Salud y Educacion, Lima, Peru
  • STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
  • Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
  • University of North Carolina Lilongwe, Malawi
  • Durban International Clinical Research Site, Durban University of Technology, South Africa
  • University of Zimbabwe Clinical Research Centre, Harare
  • Les Centres GHESKIO, Port-Au-Prince, Haiti
  • Research Institute for Health Sciences, Chiang Mai, Thailand
  • Hospital Nossa Senhora de Conceição, Porto Alegre, Brazil
  • Y. R. Gaitonde Center for AIDS Research and Education, Chennai
  • National AIDS Research Institute, Pune, India
  • Department of Medicine, University of California, Los Angeles
  • Tufts University School of Medicine, Boston, MA 
  • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD