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Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study

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Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
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School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
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Division of Epidemiology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN 37203, USA
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College of Public Health, University of Georgia, Athens, GA 30602, USA
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Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
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Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(4), 475; https://doi.org/10.3390/nu10040475
Received: 22 February 2018 / Revised: 6 April 2018 / Accepted: 10 April 2018 / Published: 12 April 2018
Impaired hematologic status (IHS) was investigated as a determinant of immune function defined as cluster of differentiation 4 (CD4) T-helper cell count, quality of life (QOL) weight and hospitalization/mortality over 18-months among 398 adult persons living with HIV/AIDS (PLWHA) on anti-retroviral therapy. IHS was defined as having anemia at baseline (Hemoglobin: <12 g/dL for women and <13 g/dL for men), time-updated anemia or having low (<30 μg/L) or high (>200 μg/L for men and >150 μg/L for women) ferritin levels at baseline. Months-to-hospitalization/death or study-end (if no event) was calculated from enrollment. Multivariable linear-mixed models quantified associations between IHS and changes in CD4 cell-count, weight gain and QOL. Cox proportional hazards models calculated hazard ratios (HR) and corresponding 95% confidence intervals (CI) for IHS-related differences in time-to-hospitalization/death. The prevalences of anemia and high and low ferritin levels at baseline were 48.7% (n = 194), 40.5% (n = 161) and 17% (n = 68), respectively. Most patients (63.4%, n = 123) remained anemic during follow-up. Weight gained (ferritin-time interaction, p < 0.01) and QOL (anemia-time interaction, p = 0.05; ferritin-time interaction, p = 0.01) were lower for PLWHA with versus without IHS. Relative to anemia-free/normal ferritin, the risk of hospitalization/death was elevated for PLWHA with anemia (HR = 2.0; 95% CI: 1.2–3.6), low or high ferritin (HR: 1.8–1.9, 95% CI: 0.9–4.1) and those that developed new/persistent/progressive anemia (HR: 2.3–6.7, 95% CI: 1.0–12.7). Among PLWHA, IHS predicted deficits in QOL, low weight gain and a high risk of hospitalization/death. Intervention to mitigate persistent IHS may be warranted among PLWHA on long-term highly active antiretroviral therapy (HAART) to improve health outcomes. View Full-Text
Keywords: HIV; anemia; ferritin; anemia persistence; ferritin; iron status; clinical outcomes HIV; anemia; ferritin; anemia persistence; ferritin; iron status; clinical outcomes
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Ezeamama, A.E.; Guwatudde, D.; Sikorskii, A.; Kabagambe, E.K.; Spelts, R.; Vahey, G.; Fenton, J.I.; Fawzi, W.W. Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study. Nutrients 2018, 10, 475.

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