埃塞俄比亚西南部未接受高效抗逆转录病毒治疗（HAART）和已接受HAART治疗的HIV阳性患者的贫血情况及危险因素：一项对比研究。
Anemia and risk factors in HAART naïve and HAART experienced HIV positive persons in south west Ethiopia: a comparative study.
作者信息
Gedefaw Lealem, Yemane Tilahun, Sahlemariam Zewdineh, Yilma Daniel
机构信息
Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Ethiopia.
出版信息
PLoS One. 2013 Aug 16;8(8):e72202. doi: 10.1371/journal.pone.0072202. eCollection 2013.
BACKGROUND
Human immunodeficiency virus (HIV) infection and its treatment cause a range of hematological abnormalities. Anemia is one of the commonly observed hematologic manifestations in HIV positive persons and it has multifactorial origin.
OBJECTIVE
We aimed to determine the prevalence and risk factors of anemia in highly active antiretroviral therapy (HAART) naïve and HAART experienced HIV positive persons.
METHODS
A facility-based comparative cross sectional study was conducted in Jimma University Specialized Hospital from February 1 to March 30, 2012. A total of 234 HIV positive persons, 117 HAART naïve and 117 HAART experienced, were enrolled in this study. Blood and stool specimens were collected from each participant. Blood specimens were examined for complete blood count, CD4 count and blood film for malaria hemoparasite; whereas stool specimens were checked for ova of intestinal parasites. Socio-demographic characteristics and clinical data of the participants were collected using pre-tested questionnaire. Statistical analysis of the data (Chi-square, student's t-test, logistic regression) was done using SPSS V-16.
RESULTS
The overall prevalence of anemia was 23.1%. The prevalence of anemia in HAART naïve and HAART experienced persons was 29.9% and 16.2%, respectively (P = 0.014). Presence of opportunistic infections (P = 0.004, 95% CI = 1.69-15.46), CD4 count <200 cells/µl (P = 0.001, 95% CI = 2.57-36.89) and rural residence (P = 0.03, 95% CI = 1.12-10.39) were found to be predictors of anemia for HAART naïve participants. On the other hand, HAART regimen (ZDV/3TC/NVP) (P = 0.019, 95% CI = 0.01-1.24) and the duration of HAART (P = 0.007, 95% CI = 0.003-0.40.24) were found to be predictors of anemia for HAART experienced groups.
CONCLUSION
The prevalence of anemia in HAART naïve persons was higher than HAART experienced persons. Risk factors for anemia in HAART naïve and HAART experienced HIV positive persons were different. Hence, there is a need for longitudinal study to further explore the causes of HIV associated anemia and the pattern of hemoglobin changes with initiation of HAART.
背景
人类免疫缺陷病毒（HIV）感染及其治疗会引发一系列血液学异常。贫血是HIV阳性者常见的血液学表现之一，其成因具有多因素性。
目的
我们旨在确定未接受高效抗逆转录病毒治疗（HAART）和已接受HAART治疗的HIV阳性者中贫血的患病率及危险因素。
方法
2012年2月1日至3月30日，在吉姆马大学专科医院开展了一项基于机构的比较横断面研究。本研究共纳入234名HIV阳性者，其中117名未接受HAART治疗，117名已接受HAART治疗。采集了每位参与者的血液和粪便样本。对血液样本进行全血细胞计数、CD4计数检查以及疟原虫血涂片检查；而粪便样本则检查肠道寄生虫虫卵。使用预先测试的问卷收集参与者的社会人口学特征和临床数据。使用SPSS V-16对数据进行统计分析（卡方检验、学生t检验、逻辑回归）。
结果
贫血的总体患病率为23.1%。未接受HAART治疗者和已接受HAART治疗者的贫血患病率分别为29.9%和16.2%（P = 0.014）。机会性感染的存在（P = 0.004，95%置信区间 = 1.69 - 15.46）、CD4计数<200个细胞/微升（P = 0.001，95%置信区间 = 2.57 - 36.89）以及农村居住（P = 0.03，95%置信区间 = 1.12 - 10.39）被发现是未接受HAART治疗参与者贫血的预测因素。另一方面，HAART治疗方案（齐多夫定/拉米夫定/奈韦拉平）（P = 0.019，95%置信区间 = 0.01 - 1.24）和HAART治疗持续时间（P = 0.007，95%置信区间 = 0.003 - 0.40.24）被发现是已接受HAART治疗组贫血的预测因素。
结论
未接受HAART治疗者的贫血患病率高于已接受HAART治疗者。未接受HAART治疗和已接受HAART治疗的HIV阳性者贫血的危险因素不同。因此，需要进行纵向研究以进一步探索HIV相关贫血的原因以及开始HAART治疗后血红蛋白变化的模式。
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