Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
J Nutr. 2024 Jun;154(6):1927-1935. doi: 10.1016/j.tjnut.2024.04.019. Epub 2024 Apr 13.
Anemia may be associated with poor clinical outcomes among people living with human immunodeficiency virus (HIV) (PLHIV) despite highly active antiretroviral therapy (HAART). There are concerns that iron supplementation may be unsafe to prevent and treat anemia among PLHIV.
The objective of the study was to evaluate the associations of anemia and iron supplementation with mortality and viral load among PLHIV in Tanzania.
We analyzed data from a cohort of 70,442 nonpregnant adult PLHIV in Tanzania conducted between 2015 and 2019. Regression models evaluated the relationships between anemia severity and iron supplement use with mortality and unsuppressed HIV-1 viral load among all participants and stratified by whether participants were initiating or continuing HAART.
Anemia was associated with an increased risk of mortality and unsuppressed viral load for participants who initiated or continued HAART. Iron supplement use was associated with reduced mortality risk but also had a greater risk of an unsuppressed viral load among participants continuing HAART. There was no association of iron supplement use with mortality, and unsuppressed viral load among PLHIV that were initiating HAART. There was a stronger negative association between iron supplement use and the risk of having an unsuppressed viral load among participants with stage III/IV disease compared with stage I/II disease.
Anemia is associated with increased risk of mortality and unsuppressed viral load, but the benefits and safety of iron supplements appear to differ for those initiating compared with continuing ART as well as by HIV disease severity.
尽管采用了高效抗逆转录病毒疗法（HAART），贫血仍可能与人类免疫缺陷病毒（HIV）感染者（PLHIV）的临床结局不良相关。人们担心铁补充剂可能不安全，无法预防和治疗 PLHIV 的贫血。
本研究旨在评估坦桑尼亚 PLHIV 贫血和铁补充与死亡率和病毒载量的关系。
我们分析了 2015 年至 2019 年间在坦桑尼亚进行的一项包含 70442 名非妊娠成年 PLHIV 的队列研究的数据。回归模型评估了贫血严重程度和铁补充剂使用与所有参与者死亡率和未抑制的 HIV-1 病毒载量之间的关系，并按参与者开始或继续接受 HAART 进行分层。
贫血与开始或继续接受 HAART 的参与者的死亡率和未抑制病毒载量增加相关。铁补充剂的使用与死亡率风险降低相关，但也增加了继续接受 HAART 的参与者未抑制病毒载量的风险。在开始接受 HAART 的 PLHIV 中，铁补充剂的使用与死亡率和未抑制病毒载量无关，且与未抑制病毒载量之间也没有关联。与 I/II 期疾病相比，III/IV 期疾病患者铁补充剂的使用与未抑制病毒载量风险之间存在更强的负相关。
贫血与死亡率和未抑制病毒载量增加相关，但与开始接受相比，铁补充剂的益处和安全性似乎在继续接受 ART 以及 HIV 疾病严重程度方面有所不同。
