Chronic anemia is more prevalent in people living with HIV (PLWH) compared to the general population. The mechanisms that drive chronic anemia in HIV are multifaceted and include functional impairment of hematopoietic stem cells, dysregulation of erythropoietin production, and persistent immune activation. Chronic inflammation from HIV infection adversely affects erythropoiesis, erythrocyte lifespan, and erythropoietin response, leading to a heightened risk of co-infections such as tuberculosis, persistent severe anemia, and increased mortality. Additionally, chronic anemia exacerbates the progression of HIV-associated nephrotoxicity and contributes to cardiovascular risk through immune activation and inflammation. This review highlights the cardinal role of chronic inflammation as a link connecting persistent anemia and cardiovascular complications in PLWH, emphasizing the need for a universal understanding of these interconnected pathways for targeted interventions.

Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV

Purpose To determine the prevalence of anemia, the morphological classification and to assess the factors associated with anemia among HIV patients attending Highly Active Antiretroviral Therapy (HAART) clinic at Hoima Regional Referral Hospital. Methods This was a cross-sectional study among 340 participants attending the HAART clinic at Hoima Regional Referral Hospital. Participants were recruited using a simple random sampling technique. A complete blood count (CBC) was performed using the Sysmex XN-550 hematology analyzer. Thick films were made and examined for malaria parasites, while thin films were examined for the morphological classification of anemia. Bivariate and multivariate logistic analyses were conducted using SPSS (version 23). Results Out of the 340 study participants, 255 (75%) were females, and the median age was 39 years (range: 6–76 years). The overall prevalence of anemia among the study participants was 16.8% (95% CI 13.1–21.1). Normocytic normochromic anemia was the most prevalent form of anemia (47.4%). The logistic regression at multivariate analysis showed that age groups (18–27 years, p = 0.017; 28–37 years, p = 0.005; and ≥38 years, p = 0.009), divorced marital status (p = 0.024), the presence of chronic disease (p = 0.010), a family history of anemia (p = 0.007), and the presence of malaria in the past one month (p = 0.001), presence of opportunistic infection (OR = 58, p = 0.000), use of antihelminthic drug in the past 3 months (OR = 0.10, p = 0.003) and unsuppressed viral load (OR = 10.74, p = 0.000) had a significant association with anemia. Conclusion Anemia is prevalent in HIV/AIDS patients who receive treatment at Hoima Regional Referral Hospital. Age, marital status, the presence of chronic illnesses, a family history of anemia, experiencing malaria in the past 3 months, the presence of opportunistic infections, the use of antihelminthic drugs in the past 3 months, and an unsuppressed viral load were significantly associated with anemia.

pdf/anemia-in-hiv-patients-attending-highly-active-2lrsbvitb7.pdf

Anemia in HIV Patients Attending Highly Active Antiretroviral Therapy Clinic at Hoima Regional Referral Hospital: Prevalence, Morphological Classification, and Associated Factors

In Equatorial Guinea, only 54 % of people living with HIV know their HIV status. There are no confirmatory or molecular diagnostic techniques for early diagnosis or monitoring of infection in the country. Rapid diagnostic tests can induce false-positive diagnoses if used as a confirmatory technique. Our study aimed to identify the challenges of early HIV diagnosis in Equatorial Guinea by analyzing the rate of false positive diagnoses, diagnostic and therapeutic delays, and treatment failures among those on antiretroviral therapy. From 2019–2022, dried blood from 341 children, adolescents and adults diagnosed in Equatorial Guinea as HIV-positive by rapid diagnostic testing, and from 54 HIV-exposed infants were collected in Bata and sent to Madrid to confirm HIV-infection by molecular (Xpert HIV-1Qual, Cepheid) and/or serological confirmatory assays (Geenius-HIV-1/2, BioRad). HIV diagnostic delay (CD4 <350cells/mm3), advanced disease at diagnosis (CD4 <200cells/mm3) and antiretroviral treatment delay and failure (viraemia >1,000RNA-HIV-1-copies/ml) were also studied after viral quantification (XpertVL HIV-1, Cepheid). False-positive diagnoses were identified in 5 % of analysed samples. HIV infection was confirmed in 90.5 % of previously diagnosed patients in Equatorial Guinea and 3.7 % of HIV-exposed children undiagnosed in the field. Two-thirds of each new HIV patient had delayed diagnosis, and one-third had advanced disease. Treatment delay occurred in 28.3 % of patients, being around four times more likely in adolescents/adults than children. More than half (56 %) of 232 treated patients presented treatment failure, being significantly higher in children/adolescents than in adults (82.9 %/90 % vs. 45.6 %, p < 0.001). We identified some challenges of early HIV diagnosis in Equatorial Guinea, revealing a high rate of false positive diagnoses, diagnostic/treatment delays, and treatment failures that need to be addressed. The implementation of more accurate rapid diagnostic techniques and confirmatory tests, along with improving access to care, treatment, awareness, and screening, would contribute to controlling the spread of HIV in the country. 

HIV diagnosis in Equatorial Guinea. Keys to reduce the diagnostic and therapeutic delay

Globally, hip fractures in elderly individuals are a prevalent and serious issue. Patients typically have a longer length of stay (LOS), which increases the risk of complications and increases hospitalization costs. Hemoglobin (Hb) is a routine blood test that is associated with disease prognosis. This study aimed to investigate the relationship between preoperative Hb and LOS in elderly hip fracture patients and to determine a reliable transfusion threshold. The clinical data of hip fracture patients (aged ≥ 60 years) admitted to the Department of Orthopaedics, Shenzhen Second People's Hospital, between January 2012 and December 2021 were retrospectively analyzed. Multiple linear regression analysis was used to assess the linear relationship between preoperative Hb and LOS. Smooth curve fitting was performed to investigate potential nonlinear relationships. In the case of discovering nonlinear relationships, a weighted two-piecewise linear regression model was built, and the inflection points were determined using a recursive algorithm. Subgroup analyses were conducted based on age and gender. A total of 1444 patients with an average age of (77.54 ± 8.73) years were enrolled. After adjusting for covariates, a nonlinear relationship was found between preoperative Hb and LOS. The two-piecewise linear regression model revealed an inflection point of 10 g/dL. On the left of the inflection point (Hb < 10 g/dL), the LOS was reduced by 0.735 days for every 1 g/dL increase in Hb (β = -0.735, 95% confidence interval: -1.346 to -0.124, P = .019). On the right side of the inflection point (Hb > 10 g/dL), the relationship was not statistically significant (β = 0.001, 95% confidence interval: -0.293 to 0.296, P = .992). In elderly hip fracture patients, there is a nonlinear association between preoperative Hb and LOS. However, when Hb levels were <10 g/dL, there was a negative correlation with the LOS. No correlation was observed when Hb levels were >10 g/dL. These findings underscore the importance of timely intervention to manage Hb levels in elderly patients with hip fractures, potentially reducing hospitalization durations and associated complications. 

Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study

Abstract Background Despite significant progress made in healthcare for PLWHA, many patients still present or re-visit healthcare centers, with advanced HIV disease, increasing their risk of death. The main causes of advanced disease are late initiation of treatment and low adherence to ART. Soluble immunological markers have prognostic significance in clinical medicine, but it is not clear whether irregular use of ART influences levels of circulating cytokines. Therefore, this study aimed to evaluate the association of cytokines to predict mortality among hospitalized PLWHA. In addition, the study evaluated the greater risk of death between ART-naive and ART-non-adherent HIV + patients with advanced disease and quantified the levels of immunological markers in postmortem whole blood samples to assess if they can be influenced by irregular use of ART. Methods Longitudinal observational study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil. In total, 111 participants were conveniently recruited between 2019 to 2021. Clinical and laboratory data were obtained from electronic medical records. From patient plasma samples, 27 types of cytokines/chemokines were measured using the Luminex Multiplex Assay within 72 hours of patient admission and 6 hours after death. Results Respiratory syndromes being the main causes of hospitalization. Pulmonary tuberculosis, neurotoxoplasmosis and oropharyngeal-esophageal candidiasis were the most prevalent opportunistic infections. The risk of death is higher among ART-naïve PLWHA. The levels of most of the 27 immunological markers were higher in those who died and post-mortem than those who were discharged from hospitalization. The increased levels of IFNγ, CCL2 and CCL3 were associated with death and increased levels of immunological markers in ART-naïve PLWH were associated with CD4 cell counts. The multivariate model showed that among post-mortem immunological markers, increased IL-17 was associated with ART-naïve PLWHA, while increased IFNγ was associated with ART experienced individuals. Conclusions ART-naïve PLWHA hospitalized with advanced disease have a higher risk of death. Some immunological markers are possible predictors of death upon hospital admission due to HIV/AIDS, and their levels increased at post-mortem. Our findings suggest a polarized response to IL-17 and IFNγ among ART-naïve and ART-experienced PLWHA, respectively. 

Association between cytokine and increased risk of death in ART- naïve and ART-non-adherence patients hospitalized with advanced HIV disease

Effect of the relationship between anaemia and systemic inflammation on the risk of incident tuberculosis and death in people with advanced HIV: a sub-analysis of the REMEMBER trial

Abstract Background Integration of a sensitive point-of-care (POC) HIV viral load (VL) test into screening algorithms may help detect acute HIV infection earlier, identify people with HIV (PWH) who are not virally suppressed, and facilitate earlier referral to antiretroviral therapy (ART), or evaluation for pre-exposure prophylaxis (PrEP). This report describes a randomized clinical trial sponsored by the Centers for Disease Control and Prevention (CDC): “Ending the HIV Epidemic Through Point-of-Care Technologies” (EHPOC). The study’s primary aim is to evaluate the use of a POC HIV VL test as part of a testing approach and assess the impact on time to linkage to ART or PrEP. The study will recruit people in Baltimore, Maryland, including patients attending a hospital emergency department, patients attending an infectious disease clinic, and people recruited via community outreach. The secondary aim is to evaluate the performance characteristics of two rapid HIV antibody tests approved by the United States Food and Drug Administration (FDA). Methods The study will recruit people 18 years or older who have risk factors for HIV acquisition and are not on PrEP, or PWH who are not taking ART. Participants will be randomly assigned to either the control arm or the intervention arm. Participants randomized to the control arm will only receive the standard-of-care (SOC) HIV screening tests. Intervention arm participants will receive a POC HIV VL test in addition to the SOC HIV diagnostic screening tests. Follow up will consist of an interim phone survey conducted at week-4 and an in-person week-12 visit. Demographic and behavioral information, and oral fluid and blood specimens will be collected at enrollment and at week-12. Survey data will be captured in a Research Electronic Data Capture (REDCap) database. Participants in both arms will be referred for either ART or PrEP based on their HIV test results. Discussion The EHPOC trial will explore a novel HIV diagnostic technology that can be performed at the POC and provide viral assessment. The study may help inform HIV testing algorithms and contribute to the evidence to support same day ART and PrEP recommendations. Trial registration NIH ClinicalTrials.gov NCT04793750. Date: 11 March 2021. 

Evaluating the impact of point-of-care HIV viral load assessment on linkage to care in Baltimore, MD: a randomized controlled trial

Quality of Life and Long COVID Incidence and Duration in the First 24 Months after Mild to Moderate Acute COVID-19: The OutSMART Prospective Cohort Study

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Effect of the relationship between anaemia and systemic inflammation on the risk of incident tuberculosis and death in people with advanced HIV: a sub-analysis of the REMEMBER trial

Evaluating the impact of point-of-care HIV viral load assessment on linkage to care in Baltimore, MD: a randomized controlled trial

Quality of Life and Long COVID Incidence and Duration in the First 24 Months after Mild to Moderate Acute COVID-19: The OutSMART Prospective Cohort Study