As a standalone indicator of HIV disease prognosis, anaemia remains a global medical issue, notably in Ethiopia and sub-Saharan Africa [22]. This study is being investigated to provide baseline information on the frequency and determinants of anaemia in individuals with HIV/AIDS receiving ART for at minimum six months at the WPH in northwest Ethiopia in the dolutegravir era. The overall prevalence of anaemia in this study was determined to be 31.5%. Most patients experienced mild to moderate anaemia. Severe anaemia seems to be less prevalent in the study population. This suggests that anaemia is a moderately troubling public health issue in the research area [1]. This level of anaemia was in accordance with published findings from the USA (30.3%) [23], Wolaita Sodo (36.5%) [15], Debre tabor (34%) [17], systematic review and meta-analysis in Ethiopia (31%) [24], Hawassa (29.9%) [25], China (39.2%) [26], and Mekele (33.5%) [27]. However, this rate is lower than that found in Jimma (51.5%) [12], Nepal (66.7%) [28], Pakistan (66.1%) [29], and Spain at (41.5%) [30]. Similarly this finding is lower than findings (66%) from a longitudinal study evaluating HIV-infected patients who initiate the 1j regimen for six months [31]. Other investigations at Goba (14.68%) [32], Poland (25.2%) [33], and Uganda (16.8%) [4], found a lower prevalence of anaemia than what was described here.
Furthermore, this study indicates that mild, moderate, and severe anaemia affected 20.42%, 10.38%, and 0.7% of study subjects, respectively. This finding is in line with the severe level of anaemia in studies conducted at Goba (0.32%) [32], Sawla (0.91%) [34], China (1.2%) [26], and Hawassa (1.7%) [25]. But this study is lower than studies in Nepal, 11.9% [28], Dessie, 2.81% [22], and Gedeo, 7.4% [35]. Whereas this result agrees with the anaemia severity seen in other studies originating in Ethiopia: Goba, 11.69%, 2.6% [32]; Dessie, 22.96%, 15.56% [22]; Gedeo, 13.1%, 14.3% [35]; Sawla, 35%, 2.73% [34]; Hawassa, 13.5%, 14.7% [25]; and Wolaita Sodo, 25%, 8.04% [15] in mild and moderate anaemia respectively. But it also agrees with studies from China 27.2%, 10.8% [26], respectively. Possible explanations for the disparity in anaemia prevalence include variations in socioeconomic status, health literacy, racial/ethnic background, years on HAART, CD4 count, viral load status, study design, sample size, inclusion criteria, and, most crucially, differences in possible cut-off values for defining anaemia [26].
Anaemia in HIV-infected individuals on ART is probably engendered by multiple factors. HIV can cause anaemia by infecting bone marrow stem cells directly, compromising erythropoiesis control, or affecting iron balance through prolonged inflammatory processes [36]. Life-long ART use has been shown to drastically diminish AIDS-related death and ameliorate anaemia [37]. Although there has been progress, the development of a viable vaccine or cure remains far off. Treatment requires lifelong therapy and constant monitoring and is linked to long-term toxicity and expenses [38]. Zidovudine (AZT) and other antiretroviral drugs may provoke bone marrow toxicity and lead to anaemia in individuals with HIV. Lamivudine (3TC) was identified as the responsible agent of pure red cell aplasia anaemia kind [39]. Recently, cases of DTG-induced acquired sideroblastic anaemia and eryptosis have been documented, potentially increasing the risk of anaemia [47].
This study delineated that the odds of being anaemic were greater among females than males. This finding was not in agreement with studies in the USA, where anaemia was negatively associated with female sex (AOR 0.30, 95% CI 0.11–0.85) [42]. Women are more prone to anaemia due to the fact that they lose more blood than men do during periods and childbirth [47].
This study found that older HIV/AIDS-positive adult patients had a higher likelihood of having anaemia. This discovery aligns with research conducted in Uganda by Kaudha et al., indicating that the occurrence of anaemia rises as individuals get older. One purported mechanism is that the younger study subjects' myeloid organs were more efficient at producing normal erythrocytes [4]. A lack of iron in the blood, which can result from a poor diet or other health issues, strikes the elderly more often than any other age group. Likewise, participants who were HIV-positive for a longer period were at greater odds as compared to the beginners. Similar findings from earlier studies [12, 17] corroborate the current finding. This may be an immediate effect of HIV infection, which can hinder erythrocyte production or speed up their destruction [24].
According to the present research, a low CD4 lymphocyte count (<200 cells/µL) was found to be significantly associated with anaemia in adults. A comprehensive review and meta-analysis in Ethiopia [24] and studies published in the United States [23] and Spain [30] were consistent with our results. This occurs in advanced HIV infection with a lowered CD4 count because of lysis and decreased synthesis of red blood cells, which leads to low hemoglobin levels [24].
Furthermore, in the current study, the history of being exposed to OIs also increases the odds of having anaemia. This finding is in concur with the study by Kaudha et al., which reveals that OIs were independently related elements for anaemia among HIV patients [4]. In addition, a systematic review and meta-analysis based on cross-sectional and cohort studies by Negesse et al. corroborates our study findings with an AOR of 1.76 (95% CI: 1.07, 2.89) [24]. The immune system's reaction to opportunistic infections causes the secretion of cytokines, which limit the body's capacity to assimilate and use iron stores [45].
This study also revealed that the odds of having anaemia were high among virological treatment failures than among virologically suppressed individuals. Studies in Spain [30] and Ethiopia [46] lend credence to this finding. The current study also uncovers that the odds of developing anaemia were higher among HIV-infected individuals at WHO clinical stages III and IV than among stage I and III participants. This study's outcome is in concordance with a systematic review and meta-analysis done on HIV-infected adult individuals in Ethiopia by Negesse et al.[24]. This is because the advanced stage of HIV causes the virus to replicate at a high rate. So, a drop in hemoglobin levels and the onset of anaemia are consequences of the defective hematopoiesis and altered coagulation processes brought about by the high viral load seen in the late stages of HIV [45].
In this study, the history of parasitosis has a positive association with anaemia. Reports by Gebrewahid et al. on the association of intestinal parasitosis with CD4 count and anaemia among ART-initiated patients in St. Mary Aksum General Hospital, Tigray, Ethiopia, supported this finding. According to the multivariate analysis of Gebrewahid et al., anaemia was strongly associated with intestinal parasitosis. Among the six parasitic genera detailed in this study, the two most common were Giardia lamblia (2.1%) and Entamoeba histolytica/dispar (18.6%) [47]. But this report didn’t consider hemoparasites, unlike our work.
Even though multivariate analysis failed to corroborate the trend reported in univariate one, univariate binary logistic regression analysis revealed that people on ART for more than 10 years were far more probable to be anemic than their contemporaries.
While a USA-based retrospective clinical cohort study reveals that HIV/AIDS-positive patients on an integrase strand transfer inhibitor (INSTI)-based regimen have higher odds of developing anaemia than other core regimens [48], participants in this study were independent of the ART regimen. This finding is in line with the previous comparative study in Nigeria, which reveals that the hemoglobin levels of HIV/AIDS-positive patients on Efavirenz combination tenofovir/lamivudine/efavirenz (TDF/3TC/EFV) are comparable with those on Ritonavir combination tenofovir/lamivudine/lopinavir/ritonavir (TDF/3TC/LPV/R) and Dolutegravir combination tenofovir/lamivudine/dolutegravir (TLD) [49].
After dolutegravir was included in the Ethiopian national ART guideline as the preferred first-line algorism in adults by 2019, this study examined the link between anaemia and HAART regimens based on dolutegravir in adult HIV-infected patients for the very first time.
Strength and Limitation of the study
All of the authors have acknowledged the study's merits and flaws. All potential confounders were controlled for in this study using multivariate logistic regression analysis. Before anything else, we can't draw any firm conclusions about the link between HIV infection and anaemia from this study because it was a hospital-based, single-centered cross-sectional analysis. Furthermore, the patient records did not contain sufficient data on some potentially important factors, including behavior, distance to the hospital, and household revenue, so this study relied on secondary sources of information.