Background A significant association between undetectable HIV-RNA at the beginning of HCV treatment and development of anaemia in co-infected patients has been reported.

Purpose To examine if adherence to highly active antiretroviral therapy (HAART) is associated with a higher incidence of anaemia.

Materials and methods Clinical records of co-infected patients treated for the HCV infection between 2009 and 2012 in a large teaching hospital were reviewed. Inclusion criteria: HCV treatment completed, ≥18 years and undetectable HIV-RNA, creatinine ≤1.6 mg/dL and haemoglobin >11 g/dL at the beginning of treatment. Demographic features and laboratory data were recorded at the start of HCV treatment. Adherence to HAART was measured by pharmacy-based time-to-refill. Non-adherence was defined as taking less than 95% of HAART doses in the six months before starting HCV treatment. Chi-squared test as well as univariate and bivariate logistic regression were performed to examine the role of adherence to HAART on the incidence of anaemia, using SPSS 19.0.

Results Fifty-three patients [46 (87%) male, average age 46 (SD: 5.9 years] were included. A total of 28 (53%) had anaemia (haemoglobin ≤11 g/dL) and 31 (58%) were considered adherent. Median baseline haemoglobin, CD4 cell count, HCV-RNA levels and length of HCV treatment were 14.8 (IQR [interquartile range]: 13.5–16) g/dL, 453 (IQR: 284–634) cells/mm³, 28 (53%) <800,000 IU/mL and 33 (IQR: 24–50.5) weeks, respectively. Adherence to HAART was significantly (P = 0.04) associated with anaemia. However, anaemia was not associated with sex, age or HCV-RNA levels. On logistic regression, both adherence to HAART OR = 3.18 [95% CI 1.01–9.93] and baseline haemoglobin OR = 0.24[0.11–0.51] were significantly associated with anaemia. This association remained significant after controlling independently for sex, age and HCV-RNA levels but not after baseline haemoglobin, CD4 cell count or creatinine.

Conclusions Adherence to HAART is associated with a higher incidence of ribavirin-induced anaemia. However, there may be others explanatory factors such as baseline haemoglobin or factors not included in this study such as drugs composing the HAART or supportive treatment for low haemoglobin levels management.

No conflict of interest.