Megaloblastic Anemia: A Drug-Induced Disorder

Barik, Satadal

doi:10.4172/2155-9864.1000359

Cited by 4 publications

(6 citation statements)

References 9 publications

(8 reference statements)

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“…10 Aside from that, AZT also acts as thymidine analogue and can interfere with DNA synthesis as well induce macrocytic anemia. 18 De Larranaga et al found a strong relation between HHcy and folate deficiency, but found no relation between Hcy levels and the side effects of AZT treatment. Based on this fact, we assume that vitamin B12 and folate deficiency did not cause macrocytic anemia in the subjects.…”

Section: Resultsmentioning

confidence: 98%

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The length of AZT consumption and homocysteine levels are protective factors of macrocytic anemia among adult HIV-infected patients: A case-control study in Central Java Province, Indonesia

Pertiwi

Suradi

Winarni

et al. 2020

Bangladesh J Med Sci

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Objective: Macrocytic anemia (MA) is the most common type of anemia in adult HIV-infected patient on azidothymidine (AZT) regimen. The common causes of MA are vitamin B12 and folate deficiency, marked by homocysteinemia. AZT consumption causes homocysteinemia is still controversial. This study aimed to determine the role of AZT consumption and homocysteinemia in developing MA. Materials and Methods: This was a case-control study involving adult HIV-infected patient who administered AZT in 12 health care facilities in Central Java Province, Indonesia. Sociodemographic data were obtained through interviews and medical records, while laboratory data included hemoglobin level and mean corpuscular volume (MCV) were measured using the automatic hematology analyzer. Homocysteine level was measured using immunoassay. WHO references was used to diagnose anemia. Macrocytic was determined when MCV >96 fl. The cut-off homocysteinemia was >10 μmol/L. Length of AZT consumption was classified into ≤6 months and >6 months. Data were analyzed using multivariate logistic regression test. Results: The population of this study was 503 adult HIVinfected on AZT regimen. In total, there were 116 subjects (age mean±SD: 41,9±9,4) who had MA and 116 controls (age mean±SD: 36,2±8,3) without anemia. Prevalence of anemia was 29.4% and the majority (78.4%) had MA. The odds of having MA among adult HIV infected patient on AZT regimen > 6 months was 0.25 times compared to patients who were on AZT regimen ≤6 months (95% CI 0.08-0.72, p=0.011), homocysteinemia was protective factor of MA (OR 0.43,95% CI 0.24-0.79, p=0.006). Conclusion: The length of AZT consumption >6 months and homocysteinemia are protective factors of MA among adult HIV-infected patient. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.638-645

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Section: Resultsmentioning

confidence: 98%

“…7 AZT acts as a thymidine analogue and can interfere with DNA synthesis, as well as inducing macrocytic anemia. 18 The most common cause of macrocytic anemia is vitamin B12 and folate deficiency. [19][20][21] Homocysteine (Hcy) is a better laboratory marker for vitamin B12 deficiency compared to vitamin B12 serum levels.…”

Section: Introductionmentioning

confidence: 99%

The length of AZT consumption and homocysteine levels are protective factors of macrocytic anemia among adult HIV-infected patients: A case-control study in Central Java Province, Indonesia

Pertiwi

Suradi

Winarni

et al. 2020

Bangladesh J Med Sci

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“…AZT has an active C atom which increases ROS (reactive oxygen species) and damages mitochondrial DNA (mtDNA) due to the accumulation of low-frequency random mutations known as mutational loads (Weil 2015). This drug has the adverse effect of decreasing the replication of human mitochondrial DNA by inhibiting the polymerase enzyme, which interferes with DNA synthesis (Barik 2016;Ghodkea et al 2012;Ukoha et al 2015). Furthermore, AZT inhibits thymidine kinase activity causing the depletion of thymidine triphosphate needed for mtDNA replication.…”

Section: Resultsmentioning

confidence: 99%

“…Zidovudine is the most common HIV drug that causes low hemoglobin (Hb) levels (Goyal et al 2016). Its consumption by the patient with this virus is known to correlate with the incidence of anemia closely and requires routine monitoring of the drug's toxic effects on Hb levels (Barik, 2016;Goyal et al, 2016;Kallianpur et al, 2016;Melese et al, 2017;Phe et al, 2013). The complication could occur in the first 2 -48 weeks after zidovudine was administered, specifically in the first 24 weeks (Kuwalairat et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Duration of Zidovudine Consumption Correlates with Anemia in People Living with HIV

Pertiwi

Sofro

Winarni

et al. 2023

J.Pharm.Sci.Community

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Anemia is the most common hematological disorder associated with Human Immunodeficiency Virus (HIV). WHO recommends zidovudine (AZT) as one of the first-line drugs for this infection. It is important to note that the drug has the adverse effect of causing anemia. Therefore, this study correlates AZT consumption duration and the incidence of anemia in HIV-infected individuals. This cross-sectional study was conducted at health service facilities using 213 participants. The data were obtained from medical records, and the assessed parameter was hemoglobin (Hb) level after less or more than a year of zidovudine administration. Furthermore, they were analyzed using a Pearson’s coefficient contingency test (p<0.05) to evaluate the correlation between groups with and without anemia at each period of drug administration. The results showed a significant correlation (p<0.05) between sex and age with anemia incidence in HIV patients administered AZT. The duration of this drug intake in HIV-infected individuals was correlated with anemia (p= 0.024; OR=0.369). This indicates the use of AZT for at least one year may be a protective factor for the incidence of anemia in patients with HIV compared to the group consuming this drug for less than one year.

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“… 3 Zidovudine is a thymidine analog that causes macrocytic anemia by interfering with DNA synthesis. 4 The accumulation in cells increases intracellular reactive oxygen species (ROS) and mitochondrial toxicity, 5 including erythrocyte damage. 6 In addition, macrocytic anemia is linked to a lack of vitamin B12 and folate.…”

Section: Introductionmentioning

confidence: 99%

A Case-Control Study of the MTHFR C665T Gene Polymorphism on Macrocytic Anemia Among HIV-Infected Patients Receiving Zidovudine

Pertiwi¹,

Sofro²,

Winarni³

et al. 2022

JMDH

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Background Macrocytic anemia is the most common anemia in HIV-infected patients receiving zidovudine, and is closely related to folate and vitamin B12 deficiencies. Homocysteine >10 μmol/L and increased MMA (methylmalonic acid) levels >24.8 ng/mL indicate high/low folate and vitamin B12 deficiencies. Furthermore, MTHFR (Methylene-tetrahydrofolate-reductase) plays an essential role in the transmethylation of homocysteine to methionine and is related to DNA synthesis. The MTHFR C665T gene polymorphism decreases the activity of MTHFR, which culminates in homocysteinemia. Therefore, this case-control aims to assess the role of the MTHFR C665T gene polymorphism on the risk of macrocytic anemia among HIV-infected individuals receiving zidovudine. Methods This study was conducted using an unmatched case-control design and the participants were HIV-infected adults aged 20 to 59 years old, receiving zidovudine for four weeks and above. A sample of 232 patients was divided into case group with macrocytic anemia and the control having no anemia. Multivariate logistic regression analysis was then implemented to determine the risk factors. Results The results showed that there was a significant difference in the number of female and male patients namely 51.3% and 48.7%, respectively, with p< 0.001. Moreover, the mean age of the cases and control group was 41.9 ± 9.4 and 36.2 ± 8.3. Regarding education, there were significant differences between subjects with low and high education 47.8% vs 52.2% with p<0.001. The majority of patients or 90.95% had taken AZT for more than 6 months. The logistic regression analysis test results showed that sex, age, education level, duration of AZT use, and homocysteine levels were predictors of macrocytic anemia with p<0.05, while MTHFR C665T gene polymorphism and MMA levels were not risk factors. Conclusion MTHFR C665T gene polymorphism does not contribute to the incidence of macrocytic anemia among HIV-infected individuals receiving zidovudine.

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Megaloblastic Anemia: A Drug-Induced Disorder

Cited by 4 publications

References 9 publications

The length of AZT consumption and homocysteine levels are protective factors of macrocytic anemia among adult HIV-infected patients: A case-control study in Central Java Province, Indonesia

The length of AZT consumption and homocysteine levels are protective factors of macrocytic anemia among adult HIV-infected patients: A case-control study in Central Java Province, Indonesia

Duration of Zidovudine Consumption Correlates with Anemia in People Living with HIV

A Case-Control Study of the MTHFR C665T Gene Polymorphism on Macrocytic Anemia Among HIV-Infected Patients Receiving Zidovudine

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