Table 3.
Modification of the associations of anemia* with mortality in HIV-infected patients initiating HAART (n = 40,657)
| Exposure status | Baseline anemia and early mortality† | Anemia during follow-up and overall mortality | ||
|---|---|---|---|---|
| Multivariate RR‡ (95% CI) | P-value | Multivariate RR§ (95% CI) | P-value | |
| Gender | 0.01 | < 0.001 | ||
| Male | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 1.70 (1.34, 2.14) | 1.65 (1.43, 1.89) | ||
| Moderate anemia | 2.46 (1.95, 3.10) | 2.57 (2.22, 2.96) | ||
| Severe anemia | 4.33 (3.36, 5.57) | 4.69 (3.98, 5.53) | ||
| Female | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 1.03 (0.86, 1.23) | 1.06 (0.94, 1.19) | ||
| Moderate anemia | 1.61 (1.36, 1.91) | 1.67 (1.49, 1.87) | ||
| Severe anemia | 2.81 (2.35, 3.37) | 3.39 (2.99, 3.84) | ||
| BMI category | < 0.001 | < 0.001 | ||
| Obese | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 1.83 (0.65, 5.14) | 1.11 (0.72, 1.69) | ||
| Moderate anemia | 6.97 (2.67, 18.21) | 3.23 (2.13, 4.89) | ||
| Severe anemia | 13.09 (4.14, 41.36) | 7.73 (4.29, 13.92) | ||
| Overweight | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 1.57 (0.86, 2.88) | 1.32 (1.00, 1.74) | ||
| Moderate anemia | 3.96 (2.22, 7.04) | 2.77 (2.09, 3.67) | ||
| Severe anemia | 9.28 (4.84, 17.81) | 8.63 (6.04, 12.33) | ||
| Normal weight | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 1.46 (1.15, 1.86) | 1.27 (1.11, 1.46) | ||
| Moderate anemia | 2.38 (1.88, 2.99) | 2.09 (1.83, 2.39) | ||
| Severe anemia | 5.56 (4.33, 7.13) | 5.25 (4.49, 6.14) | ||
| Underweight | ||||
| No anemia | 1.00 (ref) | 1.00 (ref) | ||
| Mild anemia | 0.94 (0.77, 1.14) | 1.16 (1.00, 1.35) | ||
| Moderate anemia | 1.26 (1.04, 1.51) | 1.55 (1.34, 1.79) | ||
| Severe anemia | 2.04 (1.67, 2.49) | 2.82 (2.41, 3.29) | ||
| Iron supplement use | – | < 0.001 | ||
| Yes | ||||
| No anemia | – | 1.00 (ref) | ||
| Mild anemia | – | 1.08 (0.66, 1.76) | ||
| Moderate anemia | – | 1.07 (0.68, 1.69) | ||
| Severe anemia | – | 1.65 (1.04, 2.62) | ||
| No | ||||
| No anemia | – | 1.00 (ref) | ||
| Mild anemia | – | 1.34 (1.17, 1.53) | ||
| Moderate anemia | – | 2.02 (1.76, 2.31) | ||
| Severe anemia | – | 4.06 (3.46, 4.77) | ||
| Zidovudine use‖ | – | 0.22 | ||
| Yes | ||||
| No anemia | – | 1.00 (ref) | ||
| Mild anemia | – | 1.14 (0.99, 1.31) | ||
| Moderate anemia | – | 1.73 (1.50, 1.99) | ||
| Severe anemia | – | 3.62 (2.99, 4.38) | ||
| No | ||||
| No anemia | – | 1.00 (ref) | ||
| Mild anemia | – | 1.41 (1.24, 1.61) | ||
| Moderate anemia | – | 2.25 (1.98, 2.57) | ||
| Severe anemia | – | 4.32 (3.74, 4.97) | ||
BMI = body mass index; HAART = highly active antiretroviral therapy; ref = reference; TB = tuberculosis.
* Anemia defined as follows: mild (hemoglobin 10 to < 12 g/dL in women or 10 to < 13 g/dL in men), moderate (hemoglobin 7 to < 10 g/dL), and severe (hemoglobin < 7 g/dL). No anemia was defined as hemoglobin ≥ 12 g/dL in women or hemoglobin ≥ 13 g/dL in men.
† Early mortality defined as mortality in the first 3 months of follow-up.
‡ Baseline anemia model adjusted for gender, age, district, facility level, BMI and CD4 cell count splines, WHO disease stage, alanine aminotransferase, HAART regimen, iron supplement use, TB history, TB treatment, oral candidiasis, diarrhea, season of visit, and calendar year of HAART initiation.
§ Follow-up anemia model adjusted for gender, district, calendar year of HAART initiation, and time-varying values of facility level, splines for age, BMI and CD4 cell count, WHO disease stage, alanine aminotransferase, HAART regimen, nonadherence to HAART, iron supplement use, TB treatment, oral candidiasis, and diarrhea.
‖ Model also included interaction terms for missing categories of the effect modifier, but the results are not shown.