Darmada et al. Int J Pharm Pharm Sci, Vol 12, Issue 9, 13-16 13 Original Article THE IMPACT OF ANTIRETROVIRAL THERAPY ON HEMOGLOBIN LEVELS OF HIV/AIDS PATIENTS AT MERPATI CLINIC, WANGAYA HOSPITAL, DENPASAR, BALI, INDONESIA PUTU DEWINTA DARMADA 1 , KETUT SURYANA 2 1 General Practitioner, Wangaya General Hospital in Denpasar, Bali, Indonesia, 2 Department of Internal Medicine, Wangaya HIV Study Group, Merpati Clinic, Wangaya General Hospital, Denpasar, Bali, Indonesia Email: dewinta29@gmail.com Received: 11 Jun 2020, Revised and Accepted: 13 Jul 2020 ABSTRACT Objective: Anemia is responsible for poor outcomes in HIV/AIDS patients. It’s related to disease progression, morbidity, and mortality. Antiretroviral therapy (ART) agent, zidovudine (ZDV) is also known to trigger anemia in the early initiation. However, studies found improved hemoglobin (Hb) levels of HIV/AIDS patients several months after ART routinely taken. This study aims to find the impact and correlation of ART on the hemoglobin level of HIV/AIDS patients. Methods: A retrospective cohort study was done at Merpati Clinic, Wangaya Hospital, Denpasar-Bali, Indonesia. Data were collected from medical records and laboratory results. A total sample of 64 HIV/AIDS patients with at least 6 mo on ART was included in this study. Results: Anemia was found in 34 (53.1%) of patients before ART initiation. After taking ART for 6 mo, we observed a significant improvement in patients’ hemoglobin levels, 48 (75%) shows increased hemoglobin levels. The paired t-test revealed a correlation between ART and Hb level (p<0.001). Fourteen (43.8%) patient taking ZDV shows no improvement, even declining of Hb level. Chi-square analysis performed with p = 0.001 to ZDV and lower or no improvement of hemoglobin level. Both results considered statistically significant (p-value less than 0.05) with a confidence interval (CI) of 95%. Relative risk (RR) of no improvement or decline in Hb level is 7 folds higher in the ZDV group than the non-ZDV group. Conclusion: This study concludes that ART affects hemoglobin levels in HIV/AIDS patients. Zidovudine regimen is more prone to lower or no increase of Hb. Keywords: Antiretroviral therapy, Anemia, Hemoglobin, HIV/AIDS © 2020 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ijpps.2020v12i9.38721. Journal homepage: https://innovareacademics.in/journals/index.php/ijpps. INTRODUCTION Anemia is considered as a frequently found hematological problem affecting more than one-third of HIV patients [1, 2]. Previous researches have reported that the prevalence of anemia in HIV naïve patients varies between 25.8-34.6% [2-4]. However, other studies found a higher prevalence of anemia in 71-86.4% of HIV/AIDS patients. Anemia in HIV patients correlates strongly to disease progression, morbidity, and mortality. Routine screening of anemia should be done and anemia should be properly addressed in HIV patients [5-7]. Human Immunodeficiency Virus is known to lead inflammatory cytokines discharge, erythropoiesis disturbance, depletion of hematopoietic growth factors, with malabsorption and ineffective iron recycling and eventually causing anemia [3, 6]. Several drugs in the standard regiment of Antiretroviral Therapy (ART) such as zidovudine (ZDV) affect hematopoiesis, thus contributes to anemia. The decrease of CD4 counts also strongly associated with the severity of anemia [8, 9]. Anemia can be classified into a few groups, based on the severity (mild, moderate, and severe anemia). Mild anemia is described as a hemoglobin level of 11-11.9 g/dl. Moderate anemia is when the hemoglobin level 8-10.9 g/dl. The diagnosis of severe anemia is made if the hemoglobin level is<8 g/dl [7, 10]. Antiretroviral therapy (ART) should be initiated as soon as the diagnosis of HIV infection was made. This early administration of ART aims to suppress the viral load, restore the immune system, and improve the clinical outcome in HIV patients. From a medical perspective, ART has turned the HIV diagnosis to chronic disease instead of terminal disease [9, 11]. Yesuf T et al. reported that ART initiation reduces the prevalence of anemia in HIV patients after 6 mo and 12 mo [1]. The same result also comes from another study in Ethiopia. They found that after 6 mo of ART initiation, the hemoglobin level increased significantly [7]. Another study reported that ZDV triggers anemia in HIV patients, especially 1 to 3 mo after initiation. Tamir et al., compared anemia on two groups of HIV patients. The first group is taking non-zidovudine ART and second group on ART with zidovudine. It was later found that there was a higher risk of anemia in the zidovudine group [12]. More researches should be done to establish a clear role of ART in anemic HIV patients. This study aims to find the impact of ART on the hemoglobin level of HIV patients visiting Merpati Clinic, Wangaya Hospital, Denpasar-Bali, Indonesia. MATERIALS AND METHODS Research design A retrospective cohort study was done in May 2020 at Merpati Clinic, Wangaya Hospital, Denpasar, Bali, Indonesia. The data for this study were collected from the patients’ medical records. This study was granted an ethical clearance: 02/RSUDW/litbang/2020 from local Ethical Committee. Population and sample of the study The study was held at Merpati Clinic, Wangaya Hospital, Denpasar, Bali, Indonesia in May 2020. Consecutive sampling was done, and we obtained a total of 64 HIV/AIDS patients as participants. All of the participants of this study fulfilled the inclusion and exclusion criteria. The inclusion criteria are HIV/AIDS patients with the age of 18 y old and above, with minimum Antiretroviral therapy duration of 6 mo with a complete medical record. Pregnant and lactating women, patients with chronic renal disease, and patients with thalassemia were excluded from this study. Variables and data sources Beside demographic characteristic (age, sex, weight, education, marital status), variables used on this study are; HIV/AIDS staging, International Journal of Pharmacy and Pharmaceutical Sciences Print ISSN: 2656-0097 | Online ISSN: 0975-1491 Vol 12, Issue 9, 2020