严重贫血与炎症的关系、HIV 感染者发生 IRIS 和死亡的风险：一项多国队列研究。
Association between severe anaemia and inflammation, risk of IRIS and death in persons with HIV: A multinational cohort study.
机构信息
Instituto Gon..alo Moniz, Funda...·o Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil; Programa de P..s-Gradua...·o em Patologia Humana e Experimental, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
出版信息
EBioMedicine. 2022 Nov;85:104309. doi: 10.1016/j.ebiom.2022.104309. Epub 2022 Oct 22.
BACKGROUND
After initiating antiretroviral therapy (ART), approximately 25% of people with HIV (PWH) may develop Immune Reconstitution Inflammatory Syndrome (IRIS), which is associated with increased morbidity and mortality. Several reports have demonstrated that low haemoglobin (Hb) levels are a risk factor for IRIS. To what extent the severity of anaemia contributes to the risk of IRIS and/or death is still insufficiently explored.
METHODS
We investigated both the presence and severity of anaemia in PWH in a multinational cohort of ART-na..ve patients. A large panel of plasma biomarkers was measured pre-ART and patients were followed up for 6 months. IRIS or deaths during this period were considered as outcomes. We performed multidimensional analyses, logistic regression, and survival curves to delineate associations.
FINDINGS
Patients with severe anaemia (SA) presented a distinct systemic inflammatory profile, characterized by higher TNF, IL-6, and IL-27 levels. SA was independently associated with IRIS, with a higher risk of both early IRIS onset and death. Among IRIS patients, those with SA had a higher risk of mycobacterial IRIS.
INTERPRETATION
PWH with SA display a more pronounced inflammatory profile, with an elevated risk of developing IRIS earlier and a statistically significant higher risk of death.
FUNDING
Intramural Research Program of National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH). Coordena...·o de Aperfei..oamento de Pessoal de N.ível Superior (Finance code: 001) and the Conselho Nacional de Desenvolvimento Cient.ífico e Tecnol..gico (CNPq), Brazil.
背景
在开始抗逆转录病毒治疗（ART）后，约 25%的 HIV 感染者（PWH）可能会出现免疫重建炎症综合征（IRIS），这与发病率和死亡率的增加有关。有几项报告表明，低血红蛋白（Hb）水平是 IRIS 的一个危险因素。贫血的严重程度在多大程度上导致 IRIS 和/或死亡的风险仍未得到充分探讨。
方法
我们在一个多国、ART 初治患者队列中研究了 PWH 中贫血的存在和严重程度。在 ART 前测量了大量的血浆生物标志物，并对患者进行了 6 个月的随访。在此期间发生的 IRIS 或死亡被视为结局。我们进行了多维分析、逻辑回归和生存曲线来描绘关联。
发现
严重贫血（SA）患者表现出独特的全身炎症特征，其 TNF、IL-6 和 IL-27 水平较高。SA 与 IRIS 独立相关，具有更早发生 IRIS 和死亡的更高风险。在 IRIS 患者中，SA 患者发生分枝杆菌 IRIS 的风险更高。
解释
SA 的 PWH 表现出更明显的炎症特征，发生 IRIS 的风险更早，死亡风险统计学上显著更高。
资金
美国国立过敏和传染病研究所/国立卫生研究院（NIAID/NIH）内部研究计划（资金代码：001）和巴西高级人员培训协调会（Coordena...·o de Aperfei..oamento de Pessoal de N.ível Superior）以及巴西国家科学技术发展理事会（Conselho Nacional de Desenvolvimento Cient.ífico e Tecnol..gico）。
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