Fan Hong-Wei, Guo Fu-Ping, Li Yi-Jia, Li Ning, Li Tai-Sheng
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2015 Feb 20;128(4):459-64. doi: 10.4103/0366-6999.151078.
The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.
We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.
A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30-39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200-349 cells/mm 3 (3.3%) and >350 cells/mm 3 (2.8%) compared with patients with CD4+ counts of 50-199 cells/mm 3 (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥ 50 years, HCV-Ab positivity and having a CD4+ cell count of 50-199 cells/mm 3 were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.
Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.
中国未接受抗逆转录病毒治疗（ART）的HIV感染成年患者中血小板减少症的患病率尚未得到充分描述。本研究旨在调查中国未接受ART的HIV感染成年患者中血小板减少症的患病率及相关危险因素。
我们对2005年9月至2014年8月期间中国未接受ART的HIV感染成年患者进行了一项横断面研究。从病历中获取社会人口统计学变量和实验室检查结果，包括血小板、CD4 + 细胞计数和病毒载量。使用逻辑回归评估与血小板减少症相关的因素和结果。
共纳入1730例未接受ART的HIV感染成年患者。平均年龄为38岁。血小板减少症的患病率为4.5%。与年龄大于50岁的患者（7.0%）相比，年龄<30岁（2.8%）和30 - 39岁（4.0%）的患者血小板减少症患病率存在显著差异（分别为P = 0.006和P = 0.044）。与CD4 + 细胞计数为50 - 199个细胞/mm³（7.1%）的患者相比，CD4 + 细胞计数为200 - 349个细胞/mm³（3.3%）和>350个细胞/mm³（2.8%）的患者血小板减少症患病率也存在显著差异（分别为P = 0.002和P = 0.005）。丙型肝炎病毒抗体（HCV - Ab）血清学阳性患者的血小板减少症患病率显著不同（HCV - Ab阳性为10.2%，HCV - Ab阴性为3.9%，P = 0.001）。我们观察到HIV感染传播方式不同，血小板减少症患病率也不同：血液传播（10.7%）与男男性行为传播（3.9%）（P = 0.002）以及异性传播（3.9%）（P = 0.001）相比。在二元逻辑回归分析中，年龄≥50岁、HCV - Ab阳性以及CD4 + 细胞计数为50 - 199个细胞/mm³与血小板减少症显著相关，调整后的优势比分别为2.482（95%置信区间[CI]：1.167，5.281，P = 0.018）、2.091（95%CI：1.078，4.055，P = 0.029）和2.259（95%CI：1.028，4.962，P = 0.042）。
在中国未接受ART的HIV感染成年患者中，血小板减少症并不常见。年龄较大（50岁以上）、HCV - Ab阳性以及较低的CD4 + 细胞计数与血小板减少症风险增加相关。因此，对这些患者进行血小板减少症的早期诊断和治疗是必要的。
