Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study
Objective Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemog...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/3/e031487.full |
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| author | Richard D Moore Kenneth Mayer Greer Burkholder Susan R Heckbert Barbara N Harding Bridget M Whitney Robin M Nance Heidi M Crane W Christopher Mathews Joseph J Eron Peter W Hunt Paul Volberding Michael S Saag Mari M Kitahata Joseph A C Delaney |
| author_facet | Richard D Moore Kenneth Mayer Greer Burkholder Susan R Heckbert Barbara N Harding Bridget M Whitney Robin M Nance Heidi M Crane W Christopher Mathews Joseph J Eron Peter W Hunt Paul Volberding Michael S Saag Mari M Kitahata Joseph A C Delaney |
| author_sort | Richard D Moore |
| collection | DOAJ |
| description | Objective Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemoglobin change with core ART classes in the current ART era.Design Retrospective cohort study.Setting USA-based prospective clinical cohort of PLWH aged 18 and above receiving care at eight sites between January 2010 and March 2018.Participants 16 505 PLWH were included in this study.Main outcome measures Anaemia risk and haemoglobin change were estimated among PLWH for person-time on a protease inhibitor (PI) or an integrase strand transfer inhibitor (INSTI)-based regimen, relative to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based reference. We also examined PLWH on regimens containing multiple core classes. Cox proportional hazards regression analyses were conducted to measure the associations between time-updated ART classes and incident anaemia or severe anaemia. Linear mixed effects models were used to examine the relationships between ART classes and haemoglobin change.Results During a median of 4.9 years of follow-up, 1040 developed anaemia and 488 developed severe anaemia. Compared with NNRTI use, INSTI-based regimens were associated with an increased risk of anaemia (adjusted HR (aHR) 1.26, 95% CI 1.00 to 1.58) and severe anaemia (aHR 1.51, 95% CI 1.07 to 2.11) and a decrease in haemoglobin level. Time on multiple core classes was also associated with increased anaemia risk (aHR 1.39, 95% CI 1.13 to 1.70), while no associations were found for PI use.Conclusion These findings suggest INSTI use may increase the risk of anaemia. If confirmed, screening for anaemia development in users of INSTIs may be beneficial. Further research into the underlying mechanisms is warranted. |
| format | Article |
| id | doaj-art-28b59c9b068d4cb99df435f2a86b8ae0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-28b59c9b068d4cb99df435f2a86b8ae02024-12-07T06:45:09ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-031487Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort studyRichard D Moore0Kenneth Mayer1Greer Burkholder2Susan R Heckbert3Barbara N Harding4Bridget M Whitney5Robin M Nance6Heidi M Crane7W Christopher Mathews8Joseph J Eron9Peter W Hunt10Paul Volberding11Michael S Saag12Mari M Kitahata13Joseph A C Delaney144 Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA10 The Fenway Institute at Fenway Health, Boston, Massachusetts, USA2University of Alabama at Birmingham, Medicine, Birmingham, USAEpidemiology, University of Washington, Seattle, WA, USA1Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain1 Department of Epidemiology, University of Washington, Seattle, Washington, USA1 Department of Epidemiology, University of Washington, Seattle, Washington, USA2 Medicine, University of Washington, Seattle, Washington, USA5 University of California, San Diego, La Jolla, California, USA6 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA7 University of California San Francisco, San Francisco, California, USA8 Medicine, University of California, San Francisco, San Francisco, California, USA6 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA2 Medicine, University of Washington, Seattle, Washington, USApostdoctoral fellowObjective Anaemia is common among people living with HIV (PLWH) and has been associated with certain, often older, antiretroviral medications. Information on current antiretroviral therapy (ART) and anaemia is limited. The objective was to compare the associations between anaemia incidence or haemoglobin change with core ART classes in the current ART era.Design Retrospective cohort study.Setting USA-based prospective clinical cohort of PLWH aged 18 and above receiving care at eight sites between January 2010 and March 2018.Participants 16 505 PLWH were included in this study.Main outcome measures Anaemia risk and haemoglobin change were estimated among PLWH for person-time on a protease inhibitor (PI) or an integrase strand transfer inhibitor (INSTI)-based regimen, relative to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based reference. We also examined PLWH on regimens containing multiple core classes. Cox proportional hazards regression analyses were conducted to measure the associations between time-updated ART classes and incident anaemia or severe anaemia. Linear mixed effects models were used to examine the relationships between ART classes and haemoglobin change.Results During a median of 4.9 years of follow-up, 1040 developed anaemia and 488 developed severe anaemia. Compared with NNRTI use, INSTI-based regimens were associated with an increased risk of anaemia (adjusted HR (aHR) 1.26, 95% CI 1.00 to 1.58) and severe anaemia (aHR 1.51, 95% CI 1.07 to 2.11) and a decrease in haemoglobin level. Time on multiple core classes was also associated with increased anaemia risk (aHR 1.39, 95% CI 1.13 to 1.70), while no associations were found for PI use.Conclusion These findings suggest INSTI use may increase the risk of anaemia. If confirmed, screening for anaemia development in users of INSTIs may be beneficial. Further research into the underlying mechanisms is warranted.https://bmjopen.bmj.com/content/10/3/e031487.full |
| spellingShingle | Richard D Moore Kenneth Mayer Greer Burkholder Susan R Heckbert Barbara N Harding Bridget M Whitney Robin M Nance Heidi M Crane W Christopher Mathews Joseph J Eron Peter W Hunt Paul Volberding Michael S Saag Mari M Kitahata Joseph A C Delaney Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study BMJ Open |
| title | Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study |
| title_full | Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study |
| title_fullStr | Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study |
| title_full_unstemmed | Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study |
| title_short | Antiretroviral drug class and anaemia risk in the current treatment era among people living with HIV in the USA: a clinical cohort study |
| title_sort | antiretroviral drug class and anaemia risk in the current treatment era among people living with hiv in the usa a clinical cohort study |
| url | https://bmjopen.bmj.com/content/10/3/e031487.full |
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