Yao S T, He C Y, Cao D D, Zhang Y D, Shi Y, Xiao G F, Li P Y, Xu Y W, Wei H, Sun J T, Ye R H, Yang Y C, Wang J B, He N, Ding Y Y, Duan S
Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China.
Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2021 Jul 10;42(7):1218-1224. doi: 10.3760/cma.j.cn112338-20200602-00799.
To investigate the incidence of anemia and risk factors in HIV/AIDS patients with access to antiretroviral therapy (ART) during 2004-2018 in Dehong Jingpo and Dai Autonomous Prefecture (Dehong). A retrospective cohort study was conducted in HIV/AIDS patients receiving ART in Dehong during 2004-2018 based on the data extracted from the National HIV/AIDS antiretroviral therapy database. Cox proportional risk model was used to analyze the factors associated with the incidences of anemia and moderate or severe anemia in the HIV/AIDS patients. And the piecewise linear mixed-effects model was used to depict the trajectory of hemoglobin changes over time after initiating ART according to baseline level. A total of 8 044 HIV/AIDS patients were included, in whom 6 337 (78.8%) were without anemia at baseline survey and had a median follow up time of 4.43 (, : 1.50, 6.71) years. The median follow up time for 1 291 new anemia cases and 293 new moderate or severe anemia cases was 0.16 (, : 0.07, 1.99) years and 0.48 (, :0.09, 2.97) years, respectively. The incidence rate of anemia and moderate or severe anemia was 4.40 per 100 person-years and 0.41 per 100 person-years respectively. In multivariable Cox regression analysis, older age, being female, being in Dai and Jingpo ethnic group, baseline BMI <18.5 kg/m, baseline CD4T lymphocyte cell counts (CD4) <200 cells/μl, and zidovudine (AZT) -based initial treatment regimen were factors significantly and positively associated with incidence of anemia after treatment. Factors as being female, being in Dai ethnic group, baseline BMI <18.5 kg/m, mild baseline anemia, and AZT-based initial treatment regimen were significantly and positively associated with incidence of moderate or severe anemia after treatment. The risk for anemia was higher in HIV/AIDS patients with specific characteristics, such as age ≥60 years , being female, being in Dai and Jingpo ethnic groups, lower BMI, CD4 <200 cells/μl, and treatment of AZT, after initiation of ART in Dehong during 2004-2018. Additional efforts are needed to strengthen the screening, prevention and treatment of anemia in this population.
调查2004 - 2018年期间，德宏景颇族傣族自治州（德宏）接受抗逆转录病毒治疗（ART）的HIV/AIDS患者贫血的发生率及危险因素。基于从全国HIV/AIDS抗逆转录病毒治疗数据库中提取的数据，对2004 - 2018年期间在德宏接受ART的HIV/AIDS患者进行回顾性队列研究。采用Cox比例风险模型分析HIV/AIDS患者贫血及中度或重度贫血发生率的相关因素。根据基线水平，使用分段线性混合效应模型描绘开始ART后血红蛋白随时间变化的轨迹。共纳入8044例HIV/AIDS患者，其中6337例（78.8%）在基线调查时无贫血，中位随访时间为4.43（四分位间距：1.50，6.71）年。1291例新发贫血病例和293例新发中度或重度贫血病例的中位随访时间分别为0.16（四分位间距：0.07，1.99）年和0.48（四分位间距：0.09，2.97）年。贫血和中度或重度贫血的发生率分别为每100人年4.40例和每100人年0.41例。在多变量Cox回归分析中，年龄较大、女性、景颇族和傣族、基线BMI<18.5 kg/m、基线CD4T淋巴细胞计数（CD4）<200个细胞/μl以及基于齐多夫定（AZT）的初始治疗方案是治疗后贫血发生率显著且呈正相关的因素。女性、傣族、基线BMI<18.5 kg/m、轻度基线贫血以及基于AZT的初始治疗方案是治疗后中度或重度贫血发生率显著且呈正相关的因素。2004 - 2018年期间在德宏开始ART后，具有特定特征的HIV/AIDS患者，如年龄≥60岁、女性、景颇族和傣族、BMI较低、CD4<200个细胞/μl以及接受AZT治疗，贫血风险较高。需要进一步努力加强该人群贫血的筛查、预防和治疗。
