Impact on hemoglobin of starting combination antiretroviral therapy with or without zidovudine in anemic HIV-infected patients

OBJECTIVE: 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). METHODS: We used medical records data collected in 11 US cities from 1998 to 2004. Baseline anemia was described as mild (10 < Hb < or = 12 [women] or 14 [men] g/dL), moderate (8 < Hb < or = 10 g/dL), or severe (Hb < or = 8 g/dL). Improvement of anemia was a > or =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. RESULTS: 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/microL. CONCLUSIONS: 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.