ArticleBMC medicine2015
The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study.
Article in BMC medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 of them syntheses that pooled it.
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Who cites it
45 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis.The Lancet. Infectious diseases · 2022Pooled it
- Anemia as a risk factor for tuberculosis: a systematic review and meta-analysis.Environmental health and preventive medicine · 2021Pooled it
- Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen.BMC infectious diseases · 2024Trial
- Algorithm-guided empirical tuberculosis treatment for people with advanced HIV (TB Fast Track): an open-label, cluster-randomised trial.The lancet. HIV · 2020Trial
- First-time red blood cell transfusions in the emergency department: A deficiency in micronutrient testing.Transfusion medicine (Oxford, England) · 2026Article
- Accuracy and clinical utility of near-point-of-care blood tests for predicting incident tuberculosis in exposed contacts in high burden settings: a multi-country observational cohort study.Research square · 2026Article
- Association of the monocyte-to-lymphocyte ratio with HIV viral load and anemia in HIV-positive patients: a retrospective cross-sectional study.Frontiers in cellular and infection microbiology · 2026Article
- Incidence and correlates of chronic anemia in people living with HIV Initiating ART: An exploratory five-year retrospective cohort of patients retained in care.PLOS global public health · 2026Article
- Article
- Sex differences in the risk profiles for anemia in people living with HIV, A cross sectional study.PloS one · 2025Article
- Review
- Coexistent anemia modulates systemic inflammation and exacerbates disease severity and adverse treatment outcomes in tuberculosis.Frontiers in tuberculosis · 2024Article
- Impact of Isoniazid Preventive Therapy on Tuberculosis Incidence and Predictors of Tuberculosis Among People Living With HIV/AIDS at Debre Tabor General Hospital, Northwest Ethiopia.Tuberculosis research and treatment · 2024Article
- Effect of the relationship between anaemia and systemic inflammation on the risk of incident tuberculosis and death in people with advanced HIV: a sub-analysis of the REMEMBER trial.EClinicalMedicine · 2023Article
- Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa.International journal of environmental research and public health · 2023Article
- Predictors of a high incidence of opportunistic infections among HIV-infected children receiving antiretroviral therapy at Amhara regional state comprehensive specialized hospitals, Ethiopia: A multicenter institution-based retrospective follow-up study.Frontiers in pediatrics · 2023Article
- Risk Factors for Hospitalization or Death Among Adults With Advanced HIV at Enrollment for Care in South Africa: A Secondary Analysis of the TB Fast Track Trial.Open forum infectious diseases · 2022Article
- A Clinical Prediction Model for Unsuccessful Pulmonary Tuberculosis Treatment Outcomes.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Observational
- Prevalence of anemia among people living with HIV: A systematic review and meta-analysis.EClinicalMedicine · 2022Article
- Prevalence of anaemia and associated factors among people with pulmonary tuberculosis in Uganda.Epidemiology and infection · 2022Article
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Authors and funding
6 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundLow haemoglobin concentrations may be predictive of incident tuberculosis (TB) and death in HIV-infected patients receiving antiretroviral therapy (ART), but data are limited and inconsistent. We examined these relationships retrospectively in a long-term South African ART cohort with multiple time-updated haemoglobin measurements.
methodsProspectively collected clinical data on patients receiving ART for up to 8 years in a community-based cohort were analysed. Time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded, and TB diagnoses and deaths from all causes were ascertained. Anaemia severity was classified using World Health Organization criteria. TB incidence and mortality rates were calculated and Poisson regression models were used to identify independent predictors of incident TB and mortality, respectively.
resultsDuring a median follow-up of 5.0 years (IQR, 2.5-5.8) of 1,521 patients, 476 cases of incident TB and 192 deaths occurred during 6,459 person-years (PYs) of follow-up. TB incidence rates were strongly associated with time-updated anaemia severity; those without anaemia had a rate of 4.4 (95%CI, 3.8-5.1) cases/100 PYs compared to 10.0 (95%CI, 8.3-12.1), 26.6 (95%CI, 22.5-31.7) and 87.8 (95%CI, 57.0-138.2) cases/100 PYs in those with mild, moderate and severe anaemia, respectively. Similarly, mortality rates in those with no anaemia or mild, moderate and severe time-updated anaemia were 1.1 (95%CI, 0.8-1.5), 3.5 (95%CI, 2.7-4.8), 11.8 (95%CI, 9.5-14.8) and 28.2 (95%CI, 16.5-51.5) cases/100 PYs, respectively. Moderate and severe anaemia (time-updated) during ART were the strongest independent predictors for incident TB (adjusted IRR = 3.8 [95%CI, 3.0-4.8] and 8.2 [95%CI, 5.3-12.7], respectively) and for mortality (adjusted IRR = 6.0 [95%CI, 3.9-9.2] and adjusted IRR = 8.0 [95%CI, 3.9-16.4], respectively).
conclusionsIncreasing severity of anaemia was associated with exceptionally high rates of both incident TB and mortality during long-term ART. Patients receiving ART who have moderate or severe anaemia should be prioritized for TB screening using microbiological assays and may require adjunctive clinical interventions.
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