Single-centre analysis of severe Coombs-positive autoimmune haemolytic anaemia in an HIV-endemic population

Human immunodeficiency virus (HIV) is a rare cause of autoimmune haemolytic anaemia (AIHA) which requires prompt diagnosis and treatment. We compared clinical and laboratory findings in AIHA patients with and without HIV.

We included adults with severe AIHA (haemoglobin ≤8 g/dL) diagnosed at a tertiary academic centre between 2014 and 2020. Demographic data, laboratory findings, treatment and survival outcomes were compared by HIV status. Statistical comparisons used chi-squared/Fisher's exact and Wilcoxon rank-sum tests. Kaplan-Meier estimates assessed overall survival (OS).

Fifty-five patients were included, with a median age of 48 years (interquartile range [IQR] 31-64); 64% (n = 35) were female and 38% (n = 21) people living with HIV (PLWH). PLWH presented younger (median 37 vs. 60 years, p = 0.003) and with more severe anaemia (median haemoglobin 4.0 vs. 5.4 g/dL, p = 0.015); 71% had unsuppressed HIV viraemia. Additional AIHA triggers in PLWH included lymphoproliferative disorders (14%, n = 3), drugs (10%, n = 2), co-infections and malignancy. PLWH received corticosteroids less frequently (61%, n = 11 vs. 88%, n = 30; p = 0.034) and had poorer OS (57% [95% CI 32-76] vs. 85% [95% CI 66-93] at 24 months, p = 0.016). PLWH with a CD4 count <200 cells/μL had an increased risk of death compared with HIV-negative patients (HR 4.6; 95% CI 1.2-17.3; p = 0.023).

PLWH with severe AIHA were younger, had more severe anaemia, lower corticosteroid use and poorer OS than their HIV-negative counterparts. The majority had uncontrolled HIV viraemia. These findings highlight the severity, complexity and clinical burden of AIHA in PLWH.