Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

Torsak Bunupuradah, Azar Kariminia, Kwai Cheng Chan, Reshmie Ramautarsing, Bui Vu Huy, Ning Han, Revathy Nallusamy, Rawiwan Hansudewechakul, Vonthanak Saphonn, Virat Sirisanthana, Kulkanya Chokephaibulkit, Nia Kurniati, Nagalingeswaran Kumarasamy, Nik Khairulddin Nik Yusoff, Kamarul Razali, Siew Moy Fong, Annette H. Sohn, Pagakrong Lumbiganon

Research output: Contribution to journalShort surveypeer-review

20 Citations (Scopus)


Background: There are limited data on treatment-related anemia in Asian HIV-infected children. Methods: Data from Asian HIV-infected children aged <18 years on first-line highly active antiretroviral therapy (HAART) were used. Children who had pre-existing severe anemia at baseline were excluded. Anemia was graded using the United States Division of AIDS (DAIDS) 2004 table. Potential risk factors for severe anemia were assessed by logistic regression. Results: Data from 1648 children (51.9% female, 62.8% World Health Organization (WHO) stage 3/4) were analyzed. Median (interquartile range) age was 6.8 (3.7-9.6) years, CD4% was 9 (3-16)%, and plasma HIV-RNA was 5.2 (4.7-5.6) log10 copies/ml at HAART initiation in those with available testing. The most common regimens were stavudine/lamivudine/nevirapine (42%) and zidovudine/lamivudine/nevirapine (25%). Severe anemia was identified in 47 (2.9%) children after a median time of 6 months after HAART initiation, with an incidence rate of 5.4 per 100 child-years. Mild anemia or moderate anemia at baseline (p = 0.024 and p = 0.005, respectively), previous or current use of zidovudine (p < 0.0001 and p = 0.013, respectively), and male sex (p = 0.008) were associated with severe anemia. Higher weight-for-age z-score (p = 0.004) was protective. Conclusions: The incidence of severe anemia in Asian HIV-infected children after HAART initiation was low and mainly occurred during the first few months after HAART initiation. Mild to moderate anemia at baseline and using zidovudine were independent risk factors for the development of severe anemia.

Original languageEnglish
Pages (from-to)e806-e810
JournalInternational Journal of Infectious Diseases
Issue number10
Publication statusPublished - Oct 2013


  • Anemia
  • Antiretroviral therapy
  • Asia
  • Pediatric HIV


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