The Association of Anemia With Survival Among People With HIV Following Antiretroviral Initiation in the NA-ACCORD 2007-2016.

IF 2.9 3区医学 Q3 IMMUNOLOGY

JAIDS Journal of Acquired Immune Deficiency Syndromes Pub Date : 2024-12-01 DOI:10.1097/QAI.0000000000003502

Raynell Lang, Sally B Coburn, M John Gill, Jennifer Grossman, Kelly A Gebo, Michael A Horberg, Angel M Mayor, Amy C Justice, Ronald J Bosch, Michael J Silverberg, Charles S Rabkin, Timothy R Sterling, Jennifer E Thorne, Richard D Moore, Keri N Althoff

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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2007-2016 年纳协议》中开始接受抗逆转录病毒治疗的艾滋病毒感染者中贫血与存活率的关系。

背景：贫血是预测死亡率的一个独立指标，可作为健康状况恶化的信号。我们估算了北美 HIV 感染者（PWH）在开始接受抗逆转录病毒疗法（ART）后贫血严重程度类别与死亡率之间的关系：方法：在 NA-ACCORD 中，根据世界卫生组织的标准，将 2007 年 1 月 1 日至 2016 年 12 月 31 日期间的年度血红蛋白测量中位数分为轻度（男性 11.0-12.9 克/分升，女性 11.0-11.9 克/分升）、中度（男性/女性 8.0-10.9 克/分升）和重度（结果：男性 11.0-11.9 克/分升，女性 11.0-11.9 克/分升）：在 67,228 名提供 320,261 次年度血红蛋白测量中位数的 PWH 中，257,293 人（80%）在随访期间没有贫血，44,041 人（14%）轻度贫血，18,259 人（6%）中度贫血，668 人（0.2%）重度贫血。患有（与未患有）贫血的威斯康星州心脏病患者的死亡风险高出 5.6 倍。男性（aHR=5.8 [5.4, 6.2]）与女性（aHR=4.1 [3.2, 5.4]）之间的关联更大。轻度贫血的 PWH 死亡率比无贫血的 PWH 高 3.8 倍，中度贫血的 PWH 死亡率比无贫血的 PWH 高 13.7 倍，重度贫血的 PWH 死亡率比无贫血的 PWH 高 34.5 倍。中位血红蛋白水平在死亡前4年内明显下降，最大降幅出现在死亡前一年。巨幼红细胞性贫血会增加死亡风险，而小红细胞性贫血会降低死亡风险（与正常红细胞性贫血相比）：结论：开始接受抗逆转录病毒疗法的感染者中，贫血是预测死亡率的一个重要指标，与正常细胞性贫血相比，大细胞性贫血与死亡率的相关性增加，而小细胞性贫血与死亡率的相关性降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAIDS Journal of Acquired Immune Deficiency Syndromes 医学-传染病学

CiteScore

5.80

自引率

5.60%

发文量

490

审稿时长

3-6 weeks

期刊介绍： JAIDS: Journal of Acquired Immune Deficiency Syndromes seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.