# Clinical Implications of Anemia Among Eastern Sudanese HIV Survivors

## TL;DR

This study finds that anemia is common among HIV patients in eastern Sudan, with normocytic anemia being the most prevalent form, and suggests the need for early screening and treatment.

## Contribution

The study provides the first detailed assessment of anemia prevalence and its clinical implications among HIV patients in eastern Sudan.

## Key findings

- Anemia prevalence among HIV patients in eastern Sudan is 63.6%, with mild, moderate, and severe cases at 25%, 36.4%, and 2.3%, respectively.
- Normocytic anemia was the most common type observed, affecting 64.3% of anemic patients.
- Male sex and lower total lymphocyte counts were significantly associated with higher odds of anemia.

## Abstract

Background

In HIV patients, anemia is the most common hematopoietic consequence, and it has a major influence on life satisfaction, morbidity, and survival. The epidemiology of anemia in this cohort in Sudan, however, is poorly characterized.

Aim

This study aims to assess the prevalence of anemia and its implications among HIV-positive patients.

Methods

An observational case-control study was administered in 44 clinical HIV-positive cases at the Sudan National AIDS Program (SNAP), Red Sea State, Sudan, between January 2018 and December 2019. A total of 44 HIV-negative subjects as controls were enrolled. HIV-infected patients’ demographic and clinical data, involving anemia and its outcome, were examined. WHO threshold was used to rank the clinical course of anemia in these patients.

Results

Of the 44 HIV patients examined, the mean age was 33.0 ± 11.2 years. Thirty (68.1%) were males, and 14 (29.8%) were females. The overall prevalence of anemia was 63.6% (95% CI 57.8-69.94%): mild grades of anemia at 25% (95% CI 14.4-34.4%), moderate grades of anemia at 36.4% (95% CI 28.7-43.2%), and severe anemia at 2.3% (95% CI 1.3-3.3%). In this study, 18 (64.3%) anemic patients showed normocytic thin smear pictures, among whom 44.3% were males and 20.5% were females. Microcytic anemia was seen in 17.8% of patients, while autoimmune hemolytic anemia was also detected in 17.8% of patients. The prevalence of anemia increased significantly with decreasing total lymphocyte count (TLC): 6.8% and 13.6% among patients with TLCs <1,000 and 1,000-4,800 cells/mm3, respectively (P = 0.016). Male sex was significantly associated with increased odds of anemia (OR 1.90, P = 0.049).

Conclusion

Anemia is a public comorbidity among HIV patients in the east of Sudan. Normocytosis is the most prominent form of anemia related to hypoproliferation in eastern Sudan, an event that can be triggered either by HIV chronicity or its combination with nutritional inadequacies. To prevent anemia progression and promote quality lifestyles, timely screening and appropriate therapy for anemia are critical, particularly for those with a low TLC.