评估感染和未感染艾滋病毒的卢旺达妇女的血液学参数：一项横断面研究。
Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study.
机构信息
Department of Quality Control, Institute of HIV/AIDS and Disease Prevention and Control (IHDPC) National Reference Laboratory Division, Rwanda Biomedical Center (RBC), Kigali, Rwanda.
出版信息
BMJ Open. 2012 Nov 20;2(6). doi: 10.1136/bmjopen-2012-001600. Print 2012.
OBJECTIVES
Although haematological abnormalities are common manifestations of HIV infection, few studies on haematological parameters in HIV-infected persons have been undertaken in sub-Saharan Africa. The authors assessed factors associated with haematological parameters in HIV-infected antiretroviral-naïve and HIV-uninfected Rwandan women.
STUDY DESIGN
Cross-sectional analysis of a longitudinal cohort.
SETTING
Community-based women's associations.
PARTICIPANTS
710 HIV-infected (HIV+) antiretroviral-naïve and 226 HIV-uninfected (HIV-) women from the Rwanda Women's Interassociation Study Assessment. Haematological parameters categorised as (abnormal vs normal) were compared by HIV status and among HIV+ women by CD4 count category using proportions. Multivariate logistic regression models using forward selection were fit.
RESULTS
Prevalence of anaemia (haemoglobin (Hb) <12.0 g/dl) was higher in the HIV+ group (20.5% vs 6.3%; p<0.001), and increased with lower CD4 counts: ≥350 (7.6%), 200-349 (16%) and <200 cells/mm(3) (32.2%). Marked anaemia (Hb <10.0 g/dl) was found in 4.2% of HIV+ and none of the HIV- women (p<0.001), and was highest in HIV+ women with CD4 <200 cells/mm(3) (8.4%). The HIV+ were more likely than HIV- women (4.2 vs 0.5%, respectively, p=0.002) to have moderate neutropenia with white blood cells <2.0×10(3) cells/mm(3) and 8.4% of HIV+ women with CD4 <200 cells/mm(3) had moderate neutropenia. In multivariate logistic regression analysis, BMI (OR 0.87/kg/m(2), 95% CI 0.82 to 0.93; p<0.001), CD4 200-350 vs HIV- (OR 3.59, 95% CI 1.89 to 6.83; p<0.001) and CD4 <200 cells/mm(3) vs HIV- (OR 8.09, 95% CI 4.37 to 14.97; <0.001) had large independent associations with anaemia. There were large independent associations of CD4 <200 cells/mm(3) vs HIV- (OR 7.18, 95% CI 0.78 to 65.82; p=0.081) and co-trimoxazole and/or dapsone use (OR 5.69, 95% CI 0.63 to 51.45; p=0.122) with moderate neutropenia.
CONCLUSIONS
Anaemia was more common than neutropenia or thrombocytopenia in the HIV-infected Rwandan women. Future comparisons of haematological parameters in HIV-infected patients before and after antiretroviral therapy initiation are warranted.
目的
尽管血液学异常是 HIV 感染的常见表现，但在撒哈拉以南非洲地区，针对 HIV 感染者血液学参数的研究较少。作者评估了与 HIV 感染的未接受抗逆转录病毒治疗的 HIV 阳性和未感染 HIV 的卢旺达妇女的血液学参数相关的因素。
研究设计
纵向队列的横断面分析。
地点
基于社区的妇女协会。
参与者
710 名 HIV 感染（HIV +）未经抗逆转录病毒治疗的和 226 名 HIV 未感染（HIV -）的卢旺达妇女，来自卢旺达妇女协会评估研究。使用比例比较了 HIV 状态和 HIV + 女性中 CD4 计数分类的血液学参数（异常与正常）。使用正向选择拟合多变量逻辑回归模型。
结果
贫血（血红蛋白（Hb）<12.0 g/dl）在 HIV + 组中的发生率更高（20.5% vs 6.3%；p<0.001），并且随着 CD4 计数的降低而增加：≥350（7.6%），200-349（16%）和<200 个细胞/mm（3）（32.2%）。在 4.2%的 HIV + 女性中发现了明显的贫血（Hb <10.0 g/dl），而在 HIV - 女性中则没有（p<0.001），并且在 CD4 <200 个细胞/mm（3）的 HIV + 女性中最高（8.4%）。与 HIV - 女性相比（分别为 4.2%对 0.5%，p=0.002），HIV + 女性更有可能出现白细胞<2.0×10（3）细胞/mm（3）的中度中性粒细胞减少症，并且 8.4%的 CD4 <200 个细胞/mm（3）的 HIV + 女性有中度中性粒细胞减少症。在多变量逻辑回归分析中，BMI（OR 0.87/kg/m（2），95%CI 0.82 至 0.93；p<0.001），CD4 200-350 与 HIV-（OR 3.59，95%CI 1.89 至 6.83；p<0.001）和 CD4 <200 个细胞/mm（3）与 HIV-（OR 8.09，95%CI 4.37 至 14.97；p<0.001）与贫血有很大的独立关联。CD4 <200 个细胞/mm（3）与 HIV-（OR 7.18，95%CI 0.78 至 65.82；p=0.081）和使用复方新诺明和/或氨苯砜（OR 5.69，95%CI 0.63 至 51.45；p=0.122）与中度中性粒细胞减少症有很大的独立关联。
结论
贫血在卢旺达 HIV 感染女性中比中性粒细胞减少症或血小板减少症更为常见。有必要对接受抗逆转录病毒治疗前后的 HIV 感染患者的血液学参数进行未来比较。
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