Anaemia in Acute HIV Infection Figure 1. Prevalence of anaemia (Hb,12g/dL) prior to (time = 0) and in the months following acute HIV infection vs. median HIV viral load (copies/mL). *Note: month 1 represents the first post-infection visit which occurred at a median of 42 days post-infection (range 16-86). doi:10.1371/journal.pone.0001626.g001 The pre-HIV infection mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) were 85.60 fl and 29.13 pg and declined with acute HIV infection by 1.78 fl (SD 2.74) and 0.98 pg (SD 1.46) respectively. The MCV and MCH had mean declines of 2.53 fl (SD 4.33) and 1.68 pg (SD 1.72) between acute infection and 12 months post-infection respectively. Meanwhile, the red cell distribution width (RDW) increased by 1.70% (SD 2.16) with acute infection and then increased by 0.73% (SD 2.17) between acute infection and 12 months post-infection. While the mean serum iron, vitamin B12, and folate did not change significantly at the time of acute infection, over the course of the first twelve months following infection, the mean iron level dropped to below the lower limit of normal (Table 2). The mean ferritin level increased marginally at the time of acute infection from 65.13 ng/mL prior to infection to 79.09 ng/mL with acute infection. The mean ferritin then declined steadily to 41.14 ng/mL at 6 months, and 38.09 ng/mL at 12 months (p = 0.0006 and p = 0.0165 compared with seroconversion, respectively). To determine if anaemia was correlated to disease progression, the relationship between viral load and haemoglobin level were compared at various intervals using Pearson’s correlation coeffi- cient. The Pearson’s correlation coefficient between the haemo- globin value at 3 months and the viral load closest to the time of HIV infection was significant at –0.2731 (p = 0.0398). The correlations between haemoglobin level closest to the time of infection and haemoglobin rate of decline and the viral load at various time points (closest to time of infection, 6 months post- infection, and 12 months post-infection) were not significant. Fifteen of the 57 women (26.3%) were anaemic at all of their follow-up visits. When comparing this subset of women with the rest of the group, there were no significant differences in their age, body-mass index, CD4 cell count (either at the first post-infection visit or the mean of all available visits), or median viral load. As would be expected, the mean MCV (75.8 vs. 84.5 fl, p = ,0.0001) and the mean MCH (25.1 vs. 28.2 pg, p = ,0.0001) were significantly lower for the women anaemic at every follow-up visit and the RDW (18.3% vs. 16.0%%, p = ,0.0001) was significantly Table 2. Iron studies. mean (SD) Fe (mmol/L) mean (SD) B12 (pmol/L) mean (SD) folate (nmol/L) mean (SD) ferritin (ng/mL) pre-infection (n = 28) 10.79 (5.82) 319.00 (105.08) 21.66 (10.73) 65.13 (55.82) acute infection (n = 57) 9.64 (5.56) 284.84 (164.07) 20.19 (8.08) 79.09 (87.73) 6 months post-infection (n = 43) 12 months post-infection (n = 37) 7.93 (4.62) 288.16 (141.4) 21.27 (7.29) 41.41 (42.97) 7.58 (6.10) 285.59 (129.07) 23.00 (10.09) 38.09 (42.35) Normal ranges: Fe 9.0–30.4 mmol/L, B12 132–857 pmol/L, Folate .12.19 nmol/L, ferritin 20–300 ng/mL. doi:10.1371/journal.pone.0001626.t002 PLoS ONE | www.plosone.org 3 February 2008 | Volume 3 | Issue 2 | e1626