Impact on Hemoglobin of Starting Combination Antiretroviral Therapy With or Without Zidovudine in Anemic HIV-Infected Patients

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To evaluate, among anemic patients with HIV, the impact on hemoglobin (Hb) of initiating zidovudine (AZT)-containing and non-AZT-containing combination antiretroviral therapy (cART).


We used medical records data collected in 11 US cities from 1998 to 2004. Baseline anemia was described as mild (10 < Hb ≤ 12 [women] or 14 [men] g/dL), moderate (8 < Hb ≤ 10 g/dL), or severe (Hb ≤ 8 g/dL). Improvement of anemia was a ≥1-g/dL increase in Hb, with a decrease in categoric severity. We excluded patients previously treated with erythropoietin or transfusion, and used Cox proportional hazards regression to describe factors associated with hazard of improvement of anemia.


For 1620 patients initiating cART, more than half (54%) of patients had improvement of anemia. Time to improvement of anemia was longer for those initiating AZT-containing regimens and blacks and was shorter for those with moderate and severe anemia or CD4 counts <200 cells/μL.


Most anemic patients initiating cART (with or without AZT) had increases in Hb-especially those with more severe anemia or immunosuppression. Initiation of AZT-containing cART may be considered, even for patients with preexisting anemia; however, improvement of anemia may be delayed for black patients and for patients with mild disease.

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