Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
J Nutr. 2020 Sep 1;150(9):2375-2382. doi: 10.1093/jn/nxaa172.
Hematological status may predict HIV disease progression and mortality among adults initiating highly active antiretroviral therapy (HAART).
We aimed to examine the relation of anemia and iron status at HAART initiation with survival and morbidity outcomes.
We conducted a case-cohort study of 570 HIV-infected adults initiating HAART who were enrolled in a trial of multivitamins in Tanzania. Hemoglobin, serum ferritin, and hepcidin concentrations were assessed at HAART initiation and participants were followed up monthly. We adjusted serum ferritin for inflammation using a regression correction method to characterize hematological status. Cox proportional hazards models were used to estimate HRs for mortality and incident clinical outcomes.
We found an 83% prevalence of anemia, 15% prevalence of iron deficiency anemia, and 66% prevalence of anemia of chronic diseases (ACD). The prevalence of elevated iron was 33% and 19% had iron deficiency (ID). After multivariate adjustment, severe anemia (HR: 2.57; 95% CI: 1.49, 4.45) and ACD (HR: 4.71; 95% CI: 2.91, 7.62) were associated with increased risk of mortality as compared with nonanemic participants. In addition, both ID (HR: 2.65; 95% CI: 1.08, 7.78) and elevated iron (HR: 2.83; 95% CI: 2.10, 3.82) were associated with increased risk of mortality as compared with normal iron concentrations. Severe anemia and elevated iron concentrations were associated with incident wasting and >10% weight loss (P values <0.05).
Anemia and both ID and elevated iron were associated with increased mortality among HIV-infected adults initiating HAART. Safety and efficacy studies including anemia etiology, timing of HAART initiation, and dose of iron supplementation among HIV patients appear warranted.This trial was registered at clinicaltrials.gov as NCT00383669.
血液学状态可能预测开始高效抗逆转录病毒治疗（HAART）的成年人中 HIV 疾病的进展和死亡率。
我们旨在研究 HAART 起始时贫血和铁状态与生存和发病结果的关系。
我们对在坦桑尼亚进行多种维生素试验中入组的 570 名开始 HAART 的 HIV 感染成年人进行了病例对照研究。在 HAART 开始时评估血红蛋白、血清铁蛋白和铁调素浓度，每月对参与者进行随访。我们使用回归校正法调整血清铁蛋白以描述血液学状态，对炎症进行校正。使用 Cox 比例风险模型估计死亡率和新发临床结局的 HR。
我们发现贫血的患病率为 83%，缺铁性贫血的患病率为 15%，慢性病贫血（ACD）的患病率为 66%。铁升高的患病率为 33%，缺铁的患病率为 19%。经过多变量调整后，与非贫血参与者相比，严重贫血（HR：2.57；95%CI：1.49，4.45）和 ACD（HR：4.71；95%CI：2.91，7.62）与死亡率风险增加相关。此外，与正常铁浓度相比，缺铁（HR：2.65；95%CI：1.08，7.78）和铁升高（HR：2.83；95%CI：2.10，3.82）均与死亡率风险增加相关。严重贫血和铁升高与新发消瘦和体重下降>10%（P 值均<0.05）相关。
贫血以及缺铁和铁升高均与开始 HAART 的 HIV 感染成年人的死亡率增加相关。似乎需要进行包括贫血病因学、HAART 起始时间和 HIV 患者铁补充剂量在内的安全性和有效性研究。这项试验在 clinicaltrials.gov 上注册为 NCT00383669。
