亚洲HIV感染者全血细胞减少症的特征：一项为期23年的巢式病例对照研究

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-16 DOI:10.1016/j.jiph.2025.102832

Xiangyi Shen , Xiaojing Song , Yanling Li , Xiaoxia Li , Lianfeng Lu , Xinmin Duan , Yang Han , Ling Luo , Huiting Liu , Wei Lv , Wei Cao , Taisheng Li

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引用次数: 0

摘要

全血细胞减少症是一种严重的血液学合并症，引起了HIV感染者（PLWH）发病率和死亡率增加的重大临床关注。然而，关于PLWH的发病率、危险因素、真实病因、纵向特征或管理策略的报道却缺失。通过对大量亚洲队列的长期研究，本研究旨在提供这些方面的见解。方法对2000年1月至2023年3月来我院就诊的1586名PLWH患者进行巢式病例对照研究。病例至少经历过一次全血细胞减少发作，而无此病史的对照组按年龄、性别和HIV传播途径进行匹配。对人口统计学、临床和实验室数据进行分析，以确定全血细胞减少症的危险因素、病因、临床特征和结局。结果82例（5.17 %）患者发生过1 ~ 3次红细胞减少，年发病率为2.82 %，患病率为3.71 %。晚期疾病（WHO分期3-4）是独立危险因素（aOR 2.88, 95 % CI 1.07-7.78, P = 0.03）。全血细胞减少的主要病因包括晚期HIV感染（36.3% %）和药物毒性（36.3% %）；合并感染和恶性肿瘤的病例较少。大多数全血细胞减少症发作发生在每个患者一次，通常发生在HIV诊断的早期，不需要住院治疗，并且可以在中位21周内解决。全血细胞减少症的解决伴随着病毒控制和免疫恢复。然而，危及生命的贫血（Hgb<65 g/L）是不可逆性的显著预测因子（P = 0.035）。全血细胞减少史显著影响患者生存（P = 0.008）。结论PLWH患者全血细胞减少症的发生值得警惕，尤其是晚期患者。有效的抗逆转录病毒治疗和药物审查应优先用于治疗全血细胞减少症，同时对潜在的机会性疾病进行个体化筛查。有全血细胞减少史的患者预后较差，需要引起重视。

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Characterizing pancytopenia in a large Asian cohort of people living with HIV: A 23-year nested case-control study

Background

Pancytopenia, a severe hematologic comorbidity, raises significant clinical concern for increased morbidity and mortality in people living with HIV (PLWH). However, reports on its incidence, risk factors, real-world etiologies, longitudinal characteristics, or management strategies in PLWH are absent. Through a long-term study of a large Asian cohort, this work aims to provide insights into these aspects.

Methods

We conducted a nested case-control study involving 1586 PLWH visiting our institution from January 2000 to March 2023. Cases experienced at least one pancytopenia episode, while controls with no such history were matched by age, sex, and HIV transmission route. Demographic, clinical, and laboratory data were analyzed to identify risk factors, etiologies, clinical features, and outcomes regarding pancytopenia.

Results

Pancytopenia occurred for 1–3 times in 82 patients (5.17 %), with an annual incidence of 2.82 % and a prevalence of 3.71 %. Advanced disease (WHO Stage 3–4) was an independent risk factor (aOR 2.88, 95 % CI 1.07–7.78, P = 0.03). The leading etiologies of pancytopenia included advanced HIV infection (36.3 %) and medication toxicity (36.3 %); co-infection and malignancy contributed to fewer cases. The majority of pancytopenia episodes occurred once per patient, typically within the early years of HIV diagnosis, did not require hospitalization, and could be resolved with a median of 21 weeks. Resolution of pancytopenia was accompanied by viral control and immune recovery. However, life-threatening anemia (Hgb<65 g/L) was a significant predictor for irreversibility (P = 0.035). A history of pancytopenia significantly impaired patient survival (P = 0.008).

Conclusions

Caution is warranted for the occurrence of pancytopenia in PLWH, particularly those with advanced disease. Effective antiretroviral therapy and medication review should be prioritized in managing pancytopenia, along with individualized screening for underlying opportunistic conditions. Attention is needed for patients with a history of pancytopenia due to poorer prognosis.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.