摘要
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 d
作者
李畅
谢亚莉
汪剡灵
王婷婷
林海江
陈潇潇
何纳
Li Chang;Xie Yali;Wang Shanling;Wang Tingting;Lin Haijiang;Chen Xiaoxiao;He Na(School of Public Health,Fudan University,Shanghai,200030,China)
出处
《中国初级卫生保健》
2024年第1期73-77,共5页
Chinese Primary Health Care
基金
上海市公共卫生重点学科项目(GWV-10.1-XK16)
浙江省自然科学基金(TGY23H260003)
台州市高层次人才特殊支持计划(TZ2022-2)。
关键词
HIV
贫血
发病
恶化
血红蛋白
影响因素
HIV
anemia
incidence
worsening anemia
hemoglobin
influencing factors
