Negesse Ayenew, Getaneh Temesgen, Temesgen Habtamu, Taddege Tesfahun, Jara Dube, Abebaw Zeleke
1Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
2Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
BMC Hematol. 2018 Nov 12;18:32. doi: 10.1186/s12878-018-0127-y. eCollection 2018.
Anemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level.
Studies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively.
A total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors.
This review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.
贫血是人类免疫缺陷病毒（HIV）感染成年个体中常见的血液系统疾病。然而，埃塞俄比亚在国家层面上尚无确凿的科学证据。因此，本综述特别关注埃塞俄比亚HIV感染成年个体，以估计全国范围内贫血的合并患病率及其相关因素。
按照系统评价与Meta分析方案的首选报告项目（PRISMA-P），通过搜索引擎在PUBMED/Medline、Cochrane图书馆、科学网、谷歌和谷歌学术中检索研究。采用乔安娜·布里格斯研究所统计评估与综述工具的Meta分析（JBI-MAStARI）对纳入研究进行严格评价。采用随机效应Meta分析估计贫血及其相关因素在95%置信区间的合并患病率及其各自的比值比（OR）。还进行了Meta回归以确定相关因素。此外，分别采用亚组分析、Begs和Egger检验以及修剪填充分析来评估异质性和发表偏倚。
通过检索共识别出532篇文章，其中20项研究纳入最终综述，总样本量为8079名HIV感染成年个体。贫血的合并患病率为31.00%（95%CI：23.94，38.02）。分化簇4（CD4）计数<=200个细胞/μl，OR = 3.01（95%CI：1.87，4.84）；世界卫生组织（WHO）临床分期III&IV，OR = 2.5（95%CI：1.29，4.84）；机会性感染（OIs），OR = 1.76（95%CI：1.07，2.89）；体重指数（BMI）<18.5 kg/m²，OR = 1.55（95%CI：1.28，1.88）为相关因素。
本综述表明HIV感染成年人中贫血患病率较高。发现CD4计数低、WHO临床分期III&IV、机会性感染和低BMI水平与贫血的发生有显著关联。因此，包括抗逆转录病毒治疗（ART）诊所在内的相关利益攸关方应加强机会性感染的早期诊断和潜在问题筛查的系统和程序。还应尽早筛查机会性感染和营养不良，并严格且频繁地监测HIV感染个体的CD4计数。
