UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy.
Department of Biomedicine and Prevention, University or Rome Tor Vergata, Rome, Italy.
PLoS One. 2020 Nov 10;15(11):e0242068. doi: 10.1371/journal.pone.0242068. eCollection 2020.
Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality.
We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 -December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model.
On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn't be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL.
Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.
简介： 人类免疫缺陷病毒（HIV）的感染在全球范围内非常普遍，尤其是在撒哈拉以南非洲地区，那里贫血也很普遍。已知 HIV 感染与贫血和其他各种血液学改变有关，但关于初治患者与免疫和病毒学状况的相关性以及对死亡率的影响的数据很少。我们的研究旨在调查马拉维和莫桑比克 HIV 感染者的血液学特征，并评估其与早期死亡率的可能相关性。
材料和方法： 我们对马拉维和莫桑比克 DREAM 项目 22 个卫生机构（马拉维 11 个地点，莫桑比克 11 个地点）中 HIV 阳性、初治成年患者的基线数据（一般详细信息、营养状况、全血细胞计数和 HIV 感染进展数据）和 12 个月随访情况进行了回顾性分析。2007 年 1 月至 2016 年 12 月期间，从电子病历（EMR）中收集了所有 HIV 阳性、初治患者的人口统计学特征、人体测量特征、全血细胞计数、CD4+计数和病毒载量数据。还考虑了入组后一年的随访情况。从 EMR 中提取的所有数据都包含在一个数据集，并进行分析。通过逻辑回归进行单变量和多变量分析以调查关联，Cox 回归模型进行生存分析。
结果： 总共纳入了 22657 名患者；分别有 1174 名（8.2%）和 4703 名（21.9%）患者存在严重和中度贫血。性别、营养状况、CD4+计数和病毒载量（VL）与贫血、白细胞减少和血小板减少相关。在 21166 名完全可评估的患者中，有 8494 名（40.1%）至少有一种细胞减少症。在营养状况正常和 HIV 感染程度较轻的患者中，三分之一的患者存在任何一种细胞减少症，而在基本的 HIV 护理环境中则无法诊断。在治疗的第一年，有 1725 名（整个样本的 7.6%）患者死亡。贫血、红细胞和血小板计数较低与治疗第一年的死亡率相关，且独立于体重指数、血红蛋白、CD4+计数和 VL。
结论： 尽管已知贫血与 HIV 感染的诊断有关，但在许多非洲国家并未常规进行全血细胞计数。我们的研究结果强调，在撒哈拉以南非洲的常规 HIV 护理服务中纳入更广泛的参数研究，可以提供能够预测其他改变和不良结局的重要临床信息。
