Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China.
BMC Infect Dis. 2023 Oct 19;23(1):704. doi: 10.1186/s12879-023-08675-1.
To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era.
All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death.
Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80-3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67-6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55-2.76; moderate anemia: aHR = 4.60; 95% CI:4.40-4.81; severe anemia: aHR = 6.41; 95% CI:5.94-6.91).
In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.
评估抗逆转录病毒疗法（ART）启动前后贫血的患病率，并确定在治疗所有时代中国 HIV 感染者中贫血对死亡率的影响。
纳入 2017 年 1 月 1 日至 2020 年 12 月 31 日期间新启动 ART 的所有 HIV 感染者，并随访至 2021 年 12 月 31 日。我们分析了 ART 启动前后贫血的患病率。使用广义估计方程确定 ART 后贫血相关因素。进行时间依赖性 Cox 比例风险模型估计贫血对死亡的影响。
在 ART 启动时的基线中，共有 436658 例患者，总体贫血患病率为 28.6%。在 ART 启动后中位数为 2.65（IQR：1.80-3.51）年的随访期间，有 376325（86.2%）例患者至少有一次 Hb 测量值（共 955300 次血红蛋白测量值）。ART 后每年贫血的患病率分别为 17.0%、14.1%、13.4%、12.6%和 12.7%。ART 启动时贫血（调整后的优势比，aOR=6.80，95%置信区间（CI）：6.67-6.92）是与 ART 后贫血最相关的最强因素。ART 后贫血状态与多变量调整后的死亡密切相关（轻度贫血：调整后的危害比（aHR）=2.65，95%CI：2.55-2.76；中度贫血：aHR=4.60；95%CI：4.40-4.81；重度贫血：aHR=6.41；95%CI：5.94-6.91）。
在 ART 普及时代，HIV 感染者在 ART 前贫血很常见。值得注意的是，ART 后仍存在一定比例的贫血，且与死亡显著相关。我们建议加强对贫血高危患者的监测，特别是在基线贫血或 ART 开始后的第一年，并及时治疗纠正贫血。
