SIGNIFICANCE OF PROGNOSTIC VALUE OF ANEMIA IN PREDICTING OPPORTUNISTIC INFECTIONS IN HIV-INFECTED LATE PRESENTER PATIENTS STARTING ANTIRETROVIRAL THERAPY

Introduction Anemia represents a well-known complication of HIV infection, especially in end-stage disease. Several factors could have an impact on Hemoglobin (HB) level in this disease, such as opportunistic infections, neoplasia and drugs. Many studies have demonstrated how developing of anemia is related with an higher incidence of AIDS, non-AIDS defining events or deaths, even if most of them concern to pre-HAART era; to our knowledge, few data examine the relationship between HB level at baseline and the risk of new AIDS events and new admissions to hospital among late presenters (LP) in the HAART-era. Methods We analyzed retrospectively patients’ data with new diagnosis of HIV and less than 350 T-CD4 cells/µL in period 2008-2013 in 2 HIV centers of North Italy; Santa Maria della Misericordia of Rovigo and Sant’Anna - University of Ferrara hospitals. Patients were sorted by HB level at baseline and divided in two groups: Group A and Group B, with and without anemia, respectively. Anemia was defined according the World Health Organization definition (Hb <13.0 g/dL in males, <12.0 g/dL in females). Chi-square Fisher’s exact test was emplojed to analyze differences among the two groups for new AIDS-events, new hospital admissions and virological failure. T-student test was used to evaluate differences among cell-T CD4+ in two groups. Results Of the 233 new diagnoses reported in 2008-2013 by the two centers, 47.6% were LP patients. Of these, 56 (71.8%) were males (22 Group A; 34 Group B) and 22 (28.2%) were females (12 Group A; 10 Group B). The median age of LP was 43 years (IQR 35-52) in Group A and 43 (IQR 36-52) in Group B. Risk factors related with HIV transmission were HET in 45 patients (20 Group A, 25 Group B), MSM in 12 (6 Group A, 6 Group B), IDU in 3 (2 Group A, 1 Group B), Other/Unknown 18 (6 Group A, 12 Group B). Of the 233 new diagnoses, 111 (47.6%) were LP; of these, (7.2%) died. Due to lack of data, 25 patients were excluded. 34 LP patients (43.6%) had anemia at diagnosis, compared to 44 (56.4%) patients without anemia. Total median values of T-CD4+-cells observed at the moment of diagnosis of HIV was 116/µL (IQR 59-217); in Group A, 74/µL (IQR 50-147) compared to 180/µL (IQR 76-245) (p<0,001) to Group B. HIV-RNA median level values were 140.000/mL (IQR 45.222-633.000); Group A 249.315/mL (IQR 66.248-817.000) and Group B 113.841/mL (IQR 43.011-319.000) (p>0,05). Virological failure occurred in 11 patients (32.3%) in Group A, 9 (20.5%) in Group B (p>0,05). After beginning of HAART, 9 patients developed at least one new AIDS event (total number of new AIDS-events was 13) in Group A, 1 (1 new AIDS events) in Group B (p <0,01). In Group A 10 patients needed to be admitted to hospital, instead of 8 in Group B; total number of new admissions to hospital were 24 for Group A, 10 for Group B. (p>0,05) Conclusion Despite beginning of HAART, patients who present late at diagnosis continue to have high risk of developing new AIDS-events or to be re-admitted at hospital. Both patient groups at moment of diagnosis had a median of T-CD4 cells count <200/µL, thus being at risk of developing AIDS. HB value before starting HAART seems to have an important prognostic role to pinpoint, among LP, who has an higher risk of new AIDS events. For this reason LP with anemia should be monitored with a closer follow-up to identify as soon as possible worsening of health-condition.