Duration of Zidovudine Consumption Correlates with Anemia in People Living with HIV

Danis Pertiwi; Muchlis Achsan Udji Sofro; Tri Indah Winarni; Ari Natalia Probandari

doi:10.24071/jpsc.004331

Duration of Zidovudine Consumption Correlates with Anemia in People Living with HIV

Danis Pertiwi, Muchlis Achsan Udji Sofro, Tri Indah Winarni, Ari Natalia Probandari

Abstract

Anemia is the most common hematological disorder associated with Human Immunodeficiency Virus (HIV). WHO recommends zidovudine (AZT) as one of the first-line drugs for this infection. It is important to note that the drug has the adverse effect of causing anemia. Therefore, this study correlates AZT consumption duration and the incidence of anemia in HIV-infected individuals. This cross-sectional study was conducted at health service facilities using 213 participants. The data were obtained from medical records, and the assessed parameter was hemoglobin (Hb) level after less or more than a year of zidovudine administration. Furthermore, they were analyzed using a Pearson’s coefficient contingency test (p<0.05) to evaluate the correlation between groups with and without anemia at each period of drug administration. The results showed a significant correlation (p<0.05) between sex and age with anemia incidence in HIV patients administered AZT. The duration of this drug intake in HIV-infected individuals was correlated with anemia (p= 0.024; OR=0.369). This indicates the use of AZT for at least one year may be a protective factor for the incidence of anemia in patients with HIV compared to the group consuming this drug for less than one year.

Keywords

HIV; anemia; zidovudine consumption; duration

Full Text:

PDF

References

Abbas, A., Lichtman, A., Pillai, S., 2017. Cellular and Molecular Immunology, Elsevier, Philadelphia.

Adediran, A., Osunkalu, V., Wakama, T., John-Olabode, S., Akinbami, A., Uche, E., Akanmu, S., 2016. Impact of HIV infection and zidovudine therapy on RBC parameters and urine methylmalonic acid levels. Interdisciplinary Perspectives on Infectious Diseases: 5210963.

Alamdo, A., Fiseha, T., Tesfay, A., Deber, M., Tirfe, Z., Tilahun, T. 2015. Anemia and Its Associated Risk Factors at the Time of Antiretroviral Therapy Initiation in Public Health Facilities of Arba Minch Town, Southern Ethiopia. Health. Health, 7: 1657–1664.

Assefa, M., Abegaz, W. E., Shewamare, A., Medhin, G., Belay, M. 2015. Prevalence and correlates of anemia among HIV infected patients on highly active anti-retroviral therapy at Zewditu Memorial Hospital, Ethiopia. BMC Hematology, 15(1): 1–8.

Barik, S. 2016. Megaloblastic anemia: A Drug-induced Disorder. J Blood Dis Transfus, 7: 1–3.

Bhardwaj, S., Almaeen, A., Ahmed Wani, F., Thirunavukkarasu, A. 2020. Hematologic derangements in HIV/AIDS patients and their relationship with the CD4 counts: a cross-sectional study. International Journal of Clinical and Experimental Pathology, 13(4): 756–763.

Bobat, R. 2020. HIV infection in children and adolescents. In HIV Infection in Children and Adolescents. Springer International Publishing.

Chandiwana, N. C., Chersich, M., Venter, W. D. F., Akpomiemie, G., Hill, A., Simmons, B., Lockman, S., Serenata, C. M., et al., 2021. Unexpected interactions between dolutegravir and folate: randomized trial evidence from South Africa. AIDS (London, England), 35(2): 205–211.

Dash, K. R., Meher, L. K., Hui, P. K., Behera, S. K., Nayak, S. N., 2015. High Incidence of Zidovudine Induced Anaemia in HIV Infected Patients in Southern Odisha. Indian Journal of Hematology and Blood Transfusion, 31(2): 247–250.

Deavall, D. G., Martin, E. A., Horner, J. M., Roberts, R., 2012. Drug-induced oxidative stress and toxicity. Journal of Toxicology: 645460.

Enawgaw, B., Alem, M., Addis, Z., Melku, M., 2014. Determination of Hematological and Immunological Parameters Among HIV Positive Patients Taking Highly Active Antiretroviral Treatment and Treatment Naïve in the Antiretroviral Therapy Clinic of Gondar University Hospital, Gondar, Northwest Ethiopia: A Com. BMC Hematology, 14(1): 8.

Gedefaw, L., Yemane, T., Sahlemariam, Z., Yilma, D., 2013. Anemia and Risk Factors in HAART Naïve and HAART Experienced HIV Positive Persons in South West Ethiopia: A Comparative Study. PLoS ONE, 8(8): 1–5.

Geletaw, T., Tadesse, M. Z., Demisse, A. G., 2017. Hematologic Abnormalities and Associated Factors among HIV Infected Children Pre- and Post antiretroviral Treatment, North West Ethiopia. Journal of Blood Medicine, 8: 99–105.

Ghodkea, Y., Andersonc, P., Sangkuhld, K., Lambaa, J., Altmand, R., Kleind, T., 2012. PharmGKB Summary: Zidovudine Pathway. Pharmacogenet Genom, 22: 891–894.

Goyal, V., Vaish, P., Deshmukh, A., Mishra, J., Deshmukh, G., 2016. Hematological Study (Blood and Bone Marrow) in HIV Patients. Int J Contemp Med, 4: 94–99.

Ikunaiye, N. Y., Denue, B. A., Aderemi-Williams, R., Rawizza, H.E., 2018. Incidence Of Anaemia Among Hiv Infected Patients Treated with Zidovudine-Containing Antiretroviral Therapy in Northeastern Nigeria. Annals of Ibadan Postgraduate Medicine, 16.

Johannessen, A., Naman, E., Gundersen, S. G., Bruun, J.N., 2011. Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania. BMC Infectious Diseases, 11(1): 190.

Kallianpur, A. R., Wang, Q., Jia, P., Hulgan, T., Zhao, Z., Letendre, S. L., Ellis, R. J., et al., 2016. Anemia and red blood cell indices predict HIV-associated neurocognitive impairment in the highly active antiretroviral therapy era. Journal of Infectious Diseases, 213(7): 1065–1073.

Kaushansky, K., Lichtman, M., Prchal, J., Levi, M., Press, O., Burns, L., Caligiuri, M., 2016. Williams Hematology, (9th ed.), McGraw-Hill Education, New York.

Kiragga, A. N., Castelnuovo, B., Nakanjako, D., Manabe, Y. C., 2010. Baseline severe anaemia should not preclude use of zidovudine in antiretroviral-eligible patients in resource-limited settings. Journal of the International AIDS Society, 13(1): 42.

Kementrian Kesehatan RI. 2015. Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 Tentang Pedoman Pengobatan Antiretroviral. Menteri Kesehatan Republik Indonesia Peraturan Menteri Kesehatan Republik Indonesia.

Kuwalairat, P., Winit-Watjana, W., 2014. Determinants for zidovudine-induced anemia in HIV adult patients: A Thai multicenter study. Archives of Pharmacy Practice, 5(1): 6–13.

Lin, H., Stankov, M. v, Hegermann, J., Budida, R., Panayotova-Dimitrova, D., Schmidt, R.E., Behrens, G.M.N., 2018. Zidovudine-Mediated Autophagy Inhibition Enhances Mitochondrial Toxicity in Muscle Cells., 63(1): e01443-18.

Meidani, M., Rezaei, F., Maracy, M. R., Avijgan, M., Tayeri, K., 2012. Prevalence, severity, and related factors of anemia in HIV/AIDS patients. Journal of Research in Medical Sciences, 17(2): 138–142.

Melese, H., Wassie, M. M., Woldie, H., Tadesse, A., Mesfin, N., 2017. Anemia among adult HIV patients in Ethiopia: A hospital-based cross-sectional study. HIV/AIDS - Research and Palliative Care, 9: 25–30.

Nnamani, C. P., Ezeama, N. N., Agada, O., Obiegbu, P. N., Nnamani, K.O., 2021. Prevalence, severity and relationship of anaemia with immune status and use of highly active antiretroviral therapy among human immunodeficiency virus-infected adults in south-eastern Nigeria. Journal of Health Science and Medical Research, 39(6): 435–446.

Nyambura Mugwe, J., Gicheru, M. M., Mwatha, J., 2016. Plasma Cytokine Profiles as Predictive Biomarkers of HIV and Aids Progression among HIV Patients Attending Nakuru Provincial General Hospital, Kenya. American Journal of Medical and Biological Research, 4(2): 20–25.

Opie, J. 2012. Haematological complications of HIV infection. South African Medical Journal, 102(6): 465–468.

Parkes-Ratanshi, R., Katende, D., Levin, J., Wakeham, K., Heiner, G., Kamali, A., Lalloo, D.G., 2015. Development of Severe Anemia and Changes in Hemoglobin in a Cohort of HIV-Infected Ugandan Adults Receiving Zidovudine-, Stavudine-, and Tenofovir-Containing Antiretroviral Regimens. Journal of the International Association of Providers of AIDS Care, 14(5): 455–462.

Phe, T., Thai, S., Veng, C., Sok, S., Lynen, L., van Griensven, J., 2013. Risk Factors of Treatment-Limiting Anemia after Substitution of Zidovudine for Stavudine in HIV-Infected Adult Patients on Antiretroviral Treatment. PLoS ONE, 8(3): e60206.

Redig, A. J., Berliner, N., 2013. Pathogenesis and clinical implications of HIV-related anemia, in 2013. Hematology, American Society of Hematology, Education Program, 2013(1): 377–381.

Saini, D., Agrawal, R. P., Meena, B.L., 2019. Study of Hematological Manifestations in HIV/AIDS and To Assess Their Correlation to Severity of Disease. Saudi Journal of Medicine, 04(12): 746–748.

Salem, C. Ben, Sakhri, J., Hmouda, H., 2016. Drug-Induced Megaloblastic Anemia. The New England Journal of Medicine, 374(7): 695–696.

Singh, A., Hemal, A., Agarwal, S., Dubey, N. K., Buxi, G., 2016. A prospective study of haematological changes after switching from stavudine to zidovudine-based antiretroviral treatment in HIV-infected children. International Journal of STD and AIDS, 27(13): 1145–1152.

Ukoha, U. U., Umeasalugo, K. E., Dimkpa, U., Ndukwe, G., Anyabolu, A.E., 2015. Effects of Zidovudine on Hemostatic and Hematologic Parameters in Adult Rats. J. Exp. Interg. Med., 5: 1–4.

Vaneet, A., Reshma, S. R., Somashekar, H. S., Narendranath, S., Keerthisagar, J., Dinakar, K.R., 2015. Evaluation of the effects of the anti-retroviral drug regimen (zidovudine + lamivudine + nevirapine) on CD4 count, body weight, and Hb% of the HIV patients-a retrospective study. Journal of Interdisciplinary and Multidisciplinary Research, 2(5): 177–185.

Weil, P. A., 2015. Regulation of Gene Expression, in: Harper’s Illustrated Biochemistry, pp. 428–450.

DOI: https://doi.org/10.24071/jpsc.004331