台州市HIV感染者启动抗病毒治疗后贫血发病发展情况及影响因素分析

Incidence and Risk Factors of Anemia after Initiation of ART among HIV-Infected Individuals in Taizhou

目的:了解2015—2019年浙江省台州市新确诊HIV感染者启动抗病毒治疗(antiretroviral treatment,ART)后贫血发病发展情况及其影响因素。方法:采用前瞻性队列研究的方法,纳入2015—2019年新确诊并启动ART的HIV感染者。采用Cox比例风险模型分析启动ART后贫血发病与恶化的影响因素,采用混合效应模型分析启动ART后血红蛋白随时间变化的趋势及有关因素。结果:共纳入553例HIV感染者,基线贫血患病率为21.2%(117/553)。基线436例未患贫血的HIV感染者共计随访1442.1人年,贫血发病密度为8.2/100人年。多因素Cox回归结果显示,启动ART后HIV感染者发生贫血的危险因素有年龄≥60岁(aHR=3.71,95%CI:1.61~8.59,P=0.002)、合并糖尿病(aHR=1.79,95%CI:1.03~3.13,P=0.04)、初始ART治疗方案使用齐多夫定(aHR=3.16,95%CI∶2.09~4.78,P<0.01)。基线117例患贫血的HIV感染者共计随访308.3人年,贫血恶化发病密度为9.1/100人年。多因素Cox回归结果显示贫血恶化的危险因素为合并糖尿病(aHR=2.68,95%CI:1.10~6.54,P=0.040)。年龄较高、女性、糖尿病、轻度肾功能不全、认知功能障碍者血红蛋白浓度更低,初始ART方案使用齐多夫定者血红蛋白水平有下降趋势。结论:台州市HIV感染者启动ART后贫血的发病风险在年龄较高、合并糖尿病、使用齐多夫定人群中较高,恶化风险在合并糖尿病人群中较高,应重点加强对这部分人群贫血的监测与防治。

OBJECTIVE The study aimed to investigate the incidence and development of anemia in newly diagnosed HIV-in⁃fected individuals in Taizhou,Zhejiang province,from 2015 to 2019 after initiating antiretroviral therapy(ART)and its associated factors.METHODS A prospective cohort study was conducted,including HIV-infected individuals newly diagnosed between 2015 and 2019 and initiating ART.Cox proportional hazards model was used to analyze the incidence and worsening(defined as a de⁃crease in hemoglobin levels of 10g/L or greater from baseline)of anemia after initiating ART and its influencing factors.A mixed-ef⁃fects model was used to analyze the trend and related factors of hemoglobin changes over time after starting ART.RESULTS A total of 553 HIV-infected individuals were included in the analysis.The baseline prevalence of anemia was 21.2%(117/553).Among a baseline of 436 HIV-infected individuals without anemia,there was a total follow-up duration of 1442.1 person-years,with an ane⁃mia incidence rate of 8.2 per 100 person-year.The results of the multivariate Cox regression analysis showed that the risk factors for anemia occurrence among HIV-infected individuals after initiating antiretroviral therapy(ART)were age≥60(aHR=3.71,95%CI:1.61~8.59,P=0.002),diabetes(aHR=1.79,95%CI:1.03~3.13,P=0.04),and the initial ART regimen containing zidovudine(ZDV)(aHR=3.16,95%CI:2.09~4.78,P<0.01).For the baseline of 117 HIV-infected individuals with anemia,the total follow-up duration was 308.3 person-years,with an anemia worsening incidence rate of 9.1 per 100 person-years.The risk factor for worsening anemia was diabetes(aHR=2.68,95%CI:1.10~6.54,P=0.040).Female gender,diabetes,mild renal impairment,and cognitive dysfunction were associated with lower hemoglobin levels,and the use of ZDV in the initial ART regimen was associated with a declining trend in hemoglobin levels.CONCLUSION The incidence risk of anemia in HIV-infected individuals in Taizhou following the initiation of ART is higher among older age groups,those with diabetes,and individuals using zidovudine.Moreover,the risk of anemia worsen⁃ing is elevated in the subgroup of individuals with diabetes.Therefore,it is imperative to prioritize monitoring and implementing pre⁃ventive measures for anemia in these specific populations.