艾滋病病毒感染者启动高效抗逆转录病毒疗法对贫血发病的影响

Starting effect of highly active antiretroviral therapy on the incidence of anemia in HIV-infected patients

【目的】了解上海市浦东新区接受高效抗逆转录病毒治疗(HAART)的艾滋病病毒(HIV)感染者贫血发病影响因素。【方法】在浦东新区2005—2020年启动HAART的HIV感染者中开展回顾性队列研究。使用多因素Cox回归模型分析贫血、中重度贫血及慢性贫血的新发影响因素,使用分段线性混合效应模型分析HAART与随访血红蛋白(Hb)水平的关联。【结果】共2403例HIV感染者纳入分析,新发贫血357例(总例数2178),慢性贫血86例(总例数2178),中重度贫血102例(总例数2366),发病密度分别为4.41/100人年、0.89/100人年、0.96/100人年。多因素Cox回归结果表明,女性、年龄>45岁、基线CD4^(+)T淋巴细胞计数(简称“CD4”)<200个·μL^(-1)、机会性感染、肾小球滤过率(eGFR)<60 mL·min^(-1)·(1.73 m^(2))^(-1)、基于齐多夫定(AZT)或蛋白酶抑制剂(PIs)的方案是发生贫血的相关因素;女性、年龄>45岁、CD4<200个·μL^(-1)、机会性感染、基于AZT的方案是发生慢性贫血的相关因素;基线轻度贫血及基于AZT的方案是发生中重度贫血的相关因素。线性混合效应模型显示,使用AZT(-7.87 g·L^(-1),95%CI:-9.42~-6.32)或PIs(-3.43 g·L^(-1),95%CI:-5.57~-1.30)与随访Hb较低相关。【结论】AZT或PIs与贫血发病风险增加及随访Hb较低相关。在启动HAART后半年内应加强Hb的监测。

[Objective]To investigate the risk factors of anemia in HIV-infected patients receiving highly active antiretroviral therapy(HAART)in the Pudong New Area.[Methods]A retrospective cohort study was conducted among HIV-infected patients who started HAART from 2005 to 2020 in Pudong New Area.Cox proportional hazards model was used to analyze the risk factors of anemia,moderate or severe anemia,and chronic anemia.The piecewise linear mixed-effect model was used to analyze the association between initial HAART classes and hemoglobin change in the follow-up.[Results]A total of 2403 HIV-infected patients were included in the analysis.Among them,there were 357 cases of new onset anemia,86 cases of chronic anemia and 102 cases of moderate or severe anemia,with the incidence density of 4.41/100 person years,0.89/100 person years and 0.96/100 person years respectively.Multifactorial Cox regression analysis results showed that female,age>45 years,baseline CD4^(+)T lymphocyte count(CD4)<200 cells‧μL^(-1),opportunistic infections,glomerular filtration rate(eGFR)<60 mL‧min^(-1)‧(1.73 m^(2))^(-1),and zidovudine(AZT)or protease inhibitor(PIs)based regimens were associated factors for the development of anemia.Female,age>45 years,CD4<200 cells‧μL^(-1),opportunistic infections,and AZT-based regimens were associated with the development of chronic anemia.Mild anemia at baseline and AZT-based regimens were associated with the development of moderate or severe anemia.Linear mixed-effects model showed that the use of AZT(−7.87 g‧L^(-1),95%CI:−9.42 to−6.32)or PIs(−3.43 g‧L^(-1),95%CI:−5.57 to-1.30)was associated with lower Hb at follow-up.[Conclusion]Initial use of AZT and PIs is associated with progression to anemia and a lower follow-up hemoglobin level.Increased hemoglobin monitoring in users of AZT and PIs may be beneficial,especially during the first 6 months after initiation of HAART.