Increased risk of anemia, neutropenia and thrombocytopenia in people with HIV and well-controlled viral replication

BACKGROUND: Prior to the introduction of combination antiretroviral therapy (cART), cytopenias were common in people with HIV (PWH), but it is unknown if well-controlled HIV infection is a risk factor for cytopenia. In this study we aimed to determine if HIV infection is an independent risk factor for anemia, neutropenia, lymphocytopenia, and thrombocytopenia.

METHODS: PWH with undetectable viral replication and absence of chronic hepatitis infection (n=796) were recruited from the Copenhagen Comorbidity in HIV infection (COCOMO) study and matched uninfected controls from the Copenhagen General Population Study (n=2388). Hematology was analyzed in venous blood samples. Logistic regression analyses adjusted for age, sex, ethnicity, smoking status, alcohol, and hs-CRP were performed to determine possible associations between HIV and cytopenias.

RESULTS: PWH had a higher prevalence of anemia (6.9% vs. 3.4%, P<.001), neutropenia (1.3% vs. 0.2%, P<.001), and thrombocytopenia (5.5% vs. 2.7%, P<.001) than uninfected controls. HIV was independently associated with anemia adjusted odds ratio (aOR) 2.0 (95%CI: 1.4-3.0), neutropenia aOR 6.3 (95%CI: 2.0-19.6) and thrombocytopenia aOR 2.7 (95%CI: 1.8-4.2). No association was found between HIV and lymphocytopenia.

CONCLUSIONS: Cytopenia is rare in PWH and well-controlled virus, but HIV remains a risk factor for anemia, neutropenia and thrombocytopenia and requires ongoing attention and monitoring.