Trends in prevalence of anaemia among people living with HIV in the UK: 20 cross-sectional analyses using population-based electronic primary healthcare records.

Background: People living with HIV have a greater prevalence of anaemia compared with people without HIV, which increases the risk of associated morbidity and premature mortality. Risk factors for anaemia among people living with HIV have changed in recent decades due to new antiretroviral therapy (ART), increased uptake of ART and increasing chronic conditions among people living with HIV; thus, anaemia prevalence may have changed over time. We aimed to identify the prevalence and trends of anaemia among people living with HIV over a 20-year period.

Methods: A series of 20 annual cross-sectional analyses were performed from 2002 to 2021. Data on people living with HIV aged ≥18 years from Clinical Practice Research Datalink (CPRD) Aurum was used, a population-based UK primary healthcare database. Overall and annual prevalence of all-cause anaemia, defined as any clinical code indicative of having anaemia, was calculated using multivariable logistic regression models and adjusted for age, sex, ethnicity, smoking status and deprivation. Trends were determined by investigating the change in prevalence across the 20 annual analyses using linear regression. Prevalence and trends of anaemia were also calculated among the following sub-groups of people living with HIV: age, sex, ethnicity, body mass index, smoking and socioeconomic deprivation.

Results: Data for 41 990 people living with HIV were included. Overall adjusted prevalence of anaemia was 6.89%; however, this significantly increased from 4.6% (95% CI: 4.72%, 5.06%) in 2002 to 7.42% (95% CI: 7.33%, 7.51%) in 2021. A significant positive trend for anaemia was found (adjusted coefficient + 0.123; 95% CI: 0.107, 0.139; p < 0.001) and this was consistent among all sub-groups. Females, older age (≥50 years), non-smokers, Black ethnicity, overweight/obese and higher deprivation had an increased prevalence of anaemia.

Conclusion: Anaemia among people living with HIV is increasing, with certain groups of people living with HIV experiencing a greater burden. Efforts should be made to prevent and reduce anaemia among people living with HIV to mitigate further morbidity, premature mortality and additional inequalities.