The Association of Anemia on Non-AIDS Defining Cancer and Subsequent Survival among People with HIV following Antiretroviral Initiation.

Abstract

Background: The association of anemia as a predictive and prognostic indicator of non-AIDS defining cancer (NADC) among people with HIV (PWH) remains unknown. We evaluated the presence of anemia and its severity as a predictor of NADC and 5-year all-cause survival following an NADC diagnosis among PWH who had initiated antiretroviral therapy.

Setting: North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

Methods: We included PWH (≥18 years) on ART between 01/01/2007-12/31/2016 with no prior cancer diagnosis. Annual median hemoglobin was categorized into mild (11.0-12.9g/dL men, 11.0-11.9g/dL women) and moderate/severe (<10.9g/dL regardless of sex) anemia. Discrete time-to-event models using a complementary log-log link estimated crude and adjusted hazards ratios (aHR) and 95% confidence intervals for NADC by anemia severity. Five-year mortality following NADC diagnosis by anemia was evaluated.

Results: Among 67,228 PWH contributing 301,421 annual median hemoglobin observations, 244,658 (81%) were not anemic, 40,134 (13%) had mild and 16,629 (6%) had moderate/severe anemia. The risk of NADC was higher among PWH with anemia (aHR 2.40[2.19-2.63]) (vs. no anemia) and greater among males (aHR 2.42[2.20-2.66]) than females (aHR 2.02[1.42-2.89]). NADC risk increased with worsening anemia (mild: aHR 2.01[1.81-2.23], moderate/severe: aHR 3.59[3.13-4.11]). The five-year all-cause mortality following NADC diagnosis was higher (aHR 1.37[1.21-1.55]) among PWH with anemia.

Conclusions: Among PWH who initiated ART, anemia may serve as a predictive indicator of NADC risk. Identification of anemia should warrant investigations into the underlying etiology, including evaluation for NADC. Anemia is also a prognostic indicator among PWH diagnosed with NADC.