Study Team Abstract Anaemia in Acute HIV-1 Subtype C Infection Koleka Mlisana1*, Sara C. Auld1,2, Anneke Grobler1, Francois van Loggerenberg1, Carolyn Williamson 3 , Itua Iriogbe1, Magdalena E. Sobieszczyk2, Salim S. Abdool Karim1,2, for the CAPRISA Acute Infection 1 Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, 2 Columbia University, New York, New York, United States of America, 3 Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Background: The high prevalence of anaemia and the increased morbidity and mortality associated with anaemia during AIDS has been well described yet there has been little information about anaemia and changes in haemoglobin levels during acute and early HIV-1 infection. Methods: HIV-negative women (n = 245) were enrolled into an observational cohort as part of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) Acute Infection Study. Acute infection was diagnosed following a positive HIV RNA PCR in the absence of antibodies, or detection of HIV-1 antibodies within 3 months of a previously negative antibody test. Haemotologic parameters were assessed before infection and at regular intervals in the first twelve months of HIV infection. Results: Fifty-seven participants with acute HIV infection were identified at a median of 14.5 days post-infection (range 10– 81) and were enrolled in the CAPRISA Acute Infection cohort at a median of 41 days post-infection (range 15–104). Mean haemoglobin prior to HIV-1 infection was 12.7 g/dL, with a mean decline of 0.46 g/dL following infection. The prevalence of anaemia increased from 25.0% prior to HIV-1 infection to 52.6% at 3 months post-infection, 61.1% at 6 months post- infection, and 51.4% at 12 months post-infection. Conclusions: Haematologic derangements and anaemia with a trend towards iron deficiency are common with acute HIV-1 subtype C infection in this small cohort. The negative impact of anaemia concurrent with established HIV infection upon morbidity and mortality has been well documented but the prognostic potential and long-term effects of anaemia during acute HIV-1 infection remain unknown. Citation: Mlisana K, Auld SC, Grobler A, van Loggerenberg F, Williamson C, et al (2008) Anaemia in Acute HIV-1 Subtype C Infection. PLoS ONE 3(2): e1626. doi:10.1371/journal.pone.0001626 Editor: Douglas Nixon, University of California San Francisco, United States of America Received December 6, 2007; Accepted December 15, 2007; Published February 20, 2008 Copyright: 2008 Mlisana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was funded by the Centre for the AIDs Programme of Research in South Africa (CAPRISA). CAPRISA is part of the Comprehensive International Program of Research on AIDS (CIPRA) and is supported by the National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health (NIH) and the US Department of Health and Human Services (DHHS)(grant# AI51794). The funders approved the design of the study and provided monitoring oversight thoughout the conduct of the study. The funders were not involved in the collection, analysis of data or in the preparation, review or approval of the manuscript. Competing Interests: The authors have declared that no competing interests exist. *E-mail: mlisanak@ukzn.ac.za Introduction Anaemia has been well described in established HIV-1 infection, with an estimated prevalence ranging from 10% in asymptomatic HIV-infected patients to 92% in patients with AIDS[1], but there is little data on red blood cell parameters during the acute stages of HIV-1 infection. In established HIV infection, lower haemoglobin levels have been shown to correlate with decreasing CD4+ cell counts[2] and multiple studies have found an association between anaemia during established infection and a faster progression to AIDS and death [3–9]. Many of these studies may be limited in their applicability to developing countries as they were conducted in men with predominantly HIV-1 subtype B infection. However, a study from Tanzania found that among women with World Health Organization (WHO) clinical stage 1 or 2 disease, anaemia was associated with a more rapid decline in CD4 cell count and an increased mortality [10]. The high baseline rates of anaemia in many developing countries [11] together with a growing AIDS epidemic could further increase the burden of anaemia in these regions. The aetiology of HIV-associated anaemia remains uncertain but appears to be multifactorial. Potential mechanisms include malnutrition, decreased haematopoietic cell production, dimin- ished capacity of the haematopoietic stroma to respond to increased demand, and impaired erythropoietin feedback second- ary to excess inflammatory cytokines[1,12–15]. HIV-infected patients have been noted to have reduced levels of serum iron which would suggest iron-deficiency as the cause of the anaemia, however microcytosis is rarely seen in these patients [1]. While there is limited data about anaemia during acute HIV infection, it has been suggested that anaemia at the time of seroconversion may have implications for the clinical progression of the disease [16]. In a study of 42 seroconverters from Haiti, PLoS ONE | www.plosone.org 1 February 2008 | Volume 3 | Issue 2 | e1626