Lang Raynell, Coburn Sally B, Gill M John, Grossman Jennifer, Gebo Kelly A, Horberg Michael A, Mayor Angel M, Justice Amy C, Bosch Ronald J, Silverberg Michael J, Rabkin Charles S, Sterling Timothy R, Thorne Jennifer E, Moore Richard D, Althoff Keri N
Department of Medicine, University of Calgary School of Medicine, Calgary, Alberta, Canada.
Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2024 Dec 1;97(4):334-343. doi: 10.1097/QAI.0000000000003502.
Anemia is an independent predictor of mortality, which may be utilized as a signal of deteriorating health. We estimated the association between anemia severity categories and mortality following the initiation of antiretroviral therapy (ART) among people with HIV (PWH) in North America.
Within the NA-ACCORD, annual median hemoglobin measurements between January 01, 2007, and December 31, 2016, were categorized using World Health Organization criteria into mild (11.0-12.9 g/dL men, 11.0-11.9 g/dL women), moderate (8.0-10.9 g/dL men/women), and severe (<8.0 g/dL men/women) anemia. Discrete time-to-event analyses using complementary log-log link models estimated mortality hazard ratios adjusted for demographics, comorbidities, and HIV clinical markers with 95% confidence intervals for the association between anemia and mortality.
Among 67,228 PWH contributing a total of 320,261 annual median hemoglobin measurements, 257,293 (80%) demonstrated no anemia, 44,041 (14%) mild, 18,259 (6%) moderate, and 668 (0.2%) severe anemia during follow-up. Mortality risk was 5.6-fold higher among PWH with (vs. without) anemia. The association was greater among men (adjusted hazard ratios = 5.8 [5.4, 6.2]) versus women (adjusted hazard ratios = 4.1 [3.2, 5.4]). Mortality risk was 3.8-fold higher among PWH with mild anemia, 13.7-fold higher with moderate anemia, and 34.5-fold higher with severe anemia (vs. no anemia). Median hemoglobin levels decreased significantly in the 4 years before death, with a maximum decrease in the year before death. Macrocytic anemia was associated with an increased mortality risk and microcytic anemia was associated with a decreased mortality risk (vs. normocytic anemia).
Anemia among PWH who have initiated ART is an important predictive marker for mortality with macrocytic anemia having an increased association and microcytic anemia having a decreased association with mortality compared with normocytic anemia.
贫血是死亡率的独立预测因素，可作为健康状况恶化的信号。我们估计了北美感染艾滋病毒者（PWH）开始抗逆转录病毒治疗（ART）后贫血严重程度类别与死亡率之间的关联。
在北美艾滋病队列协作研究（NA - ACCORD）中，2007年1月1日至2016年12月31日期间的年度血红蛋白中位数测量值，根据世界卫生组织标准分为轻度贫血（男性11.0 - 12.9 g/dL，女性11.0 - 11.9 g/dL）、中度贫血（男性/女性8.0 - 10.9 g/dL）和重度贫血（男性/女性<8.0 g/dL）。使用互补对数 - 对数链接模型进行离散事件时间分析，估计死亡率风险比，并针对人口统计学、合并症和艾滋病毒临床标志物进行调整，得出贫血与死亡率之间关联的95%置信区间。
在67,228名PWH中，共进行了320,261次年度血红蛋白中位数测量，随访期间，257,293人（80%）无贫血，44,041人（14%）为轻度贫血，18,259人（6%）为中度贫血，668人（0.2%）为重度贫血。有贫血的PWH的死亡风险比无贫血者高5.6倍。男性（调整后的风险比 = 5.8 [5.4, 6.2]）与女性（调整后的风险比 = 4.1 [3.2, 5.4]）相比，这种关联更强。轻度贫血的PWH的死亡风险高3.8倍，中度贫血高13.7倍，重度贫血高34.5倍（与无贫血相比）。死亡前4年血红蛋白中位数水平显著下降，死亡前一年下降幅度最大。大细胞性贫血与死亡风险增加相关，小细胞性贫血与死亡风险降低相关（与正细胞性贫血相比）。
开始接受抗逆转录病毒治疗的PWH中的贫血是死亡率的重要预测指标，与正细胞性贫血相比，大细胞性贫血与死亡率的关联增加，小细胞性贫血与死亡率的关联降低。
