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Abstract：
BACKGROUND: Anemia is common and associated with increased morbidity among people with HIV (PWH). Classification of anemia using the mean corpuscular volume (MCV) can help investigate the underlying causative factors of anemia. We characterize anemia using MCV among PWH receiving antiretroviral therapy (ART), and identify the risk factors for normocytic, macrocytic, and microcytic anemias.
METHODS: Including PWH with anemia (hemoglobin measure < 12.9 g/dL among men and < 11.9 g/dL among women) in the NA-ACCORD from 01/01/2007 to 12/31/2017, we estimated the annual distribution of normocytic (80-100 femtolitre (fL)), macrocytic (> 100 fL) or microcytic (< 80 fL) anemia based on the lowest hemoglobin within each year. Poisson regression models with robust variance and general estimating equations were used to estimate crude and adjusted prevalence ratios and 95% confidence intervals for risk factors for macrocytic (vs. normocytic) and microcytic (vs. normocytic) anemia stratified by sex.
RESULTS: Among 37,984 hemoglobin measurements that identified anemia in 14,590 PWH, 27,909 (74%) were normocytic, 4257 (11%) were microcytic, and 5818 (15%) were macrocytic. Of the anemic PWH included over the study period, 1910 (13%) experienced at least one measure of microcytic anemia and 3208 (22%) at least one measure of macrocytic anemia. Normocytic anemia was most common among both males and females, followed by microcytic among females and macrocytic among males. Over time, the proportion of anemic PWH who have macrocytosis decreased while microcytosis increased. Macrocytic (vs. normocytic) anemia is associated with increasing age and comorbidities. With increasing age, microcytic anemia decreased among females but not males. A greater proportion of PWH with normocytic anemia had CD4 counts ≤ 200 cells/mm3 and had recently initiated ART.
CONCLUSIONS: In anemic PWH, normocytic anemia was most common. Over time macrocytic anemia decreased, and microcytic anemia increased irrespective of sex. Normocytic anemia is often due to chronic disease and may explain the greater risk for normocytic anemia among those with lower CD4 counts or recent ART initiation. Identified risk factors for type-specific anemias including sex, age, comorbidities, and HIV factors, can help inform targeted investigation into the underlying causes.
METHODS: Including PWH with anemia (hemoglobin measure < 12.9 g/dL among men and < 11.9 g/dL among women) in the NA-ACCORD from 01/01/2007 to 12/31/2017, we estimated the annual distribution of normocytic (80-100 femtolitre (fL)), macrocytic (> 100 fL) or microcytic (< 80 fL) anemia based on the lowest hemoglobin within each year. Poisson regression models with robust variance and general estimating equations were used to estimate crude and adjusted prevalence ratios and 95% confidence intervals for risk factors for macrocytic (vs. normocytic) and microcytic (vs. normocytic) anemia stratified by sex.
RESULTS: Among 37,984 hemoglobin measurements that identified anemia in 14,590 PWH, 27,909 (74%) were normocytic, 4257 (11%) were microcytic, and 5818 (15%) were macrocytic. Of the anemic PWH included over the study period, 1910 (13%) experienced at least one measure of microcytic anemia and 3208 (22%) at least one measure of macrocytic anemia. Normocytic anemia was most common among both males and females, followed by microcytic among females and macrocytic among males. Over time, the proportion of anemic PWH who have macrocytosis decreased while microcytosis increased. Macrocytic (vs. normocytic) anemia is associated with increasing age and comorbidities. With increasing age, microcytic anemia decreased among females but not males. A greater proportion of PWH with normocytic anemia had CD4 counts ≤ 200 cells/mm3 and had recently initiated ART.
CONCLUSIONS: In anemic PWH, normocytic anemia was most common. Over time macrocytic anemia decreased, and microcytic anemia increased irrespective of sex. Normocytic anemia is often due to chronic disease and may explain the greater risk for normocytic anemia among those with lower CD4 counts or recent ART initiation. Identified risk factors for type-specific anemias including sex, age, comorbidities, and HIV factors, can help inform targeted investigation into the underlying causes.
摘要：
背景：在HIV（PWH）患者中，贫血很常见，并且与发病率增加有关。使用平均红细胞体积（MCV）对贫血进行分类可以帮助研究贫血的潜在致病因素。我们在接受抗逆转录病毒治疗（ART）的PWH中使用MCV表征贫血，并确定正常细胞的危险因素，大细胞,和小细胞贫血。
方法：包括2007年1月1日至2017年12月31日NA-ACCORD中贫血的PWH（男性血红蛋白<12.9g/dL，女性<11.9g/dL），我们估计了正常细胞（80-100毫微微（fL））的年度分布，基于每年最低血红蛋白的大红细胞（>100fL）或小红细胞（<80fL）贫血。使用具有稳健方差和一般估计方程的泊松回归模型来估计粗和经调整的患病率比率以及大红细胞风险因素的95％置信区间（与正常细胞)和微细胞(vs.正常细胞）贫血。
结果：在14,590PWH中确定贫血的37,984项血红蛋白测量中，27,909（74％）为正常细胞，4257（11%）为小细胞，5818（15％）是大细胞。在研究期间包括的贫血PWH中，1910（13％）经历了至少一种小细胞性贫血的测量，3208（22％）经历了至少一种大细胞性贫血的测量。正常细胞性贫血在男性和女性中最常见，其次是雌性的小细胞和雄性的大细胞。随着时间的推移,贫血的PWH中，大细胞增多的比例降低，而小细胞增多。大细胞（vs.正常细胞）贫血与年龄增加和合并症有关。随着年龄的增长,小红细胞性贫血在女性中有所减少，但男性没有。正常细胞性贫血的PWH中CD4计数≤200个细胞/mm3的比例更高，并且最近开始了ART。
结论：在贫血PWH中，正常细胞性贫血是最常见的。随着时间的推移，大细胞性贫血减少，和小红细胞性贫血增加不分性别。正常细胞性贫血通常是由于慢性疾病，并且可以解释在CD4计数较低或最近开始ART的人群中，正常细胞性贫血的风险更大。确定类型特异性贫血的风险因素，包括性别，年龄,合并症,和艾滋病毒因素，可以帮助有针对性地调查根本原因。
方法：包括2007年1月1日至2017年12月31日NA-ACCORD中贫血的PWH（男性血红蛋白<12.9g/dL，女性<11.9g/dL），我们估计了正常细胞（80-100毫微微（fL））的年度分布，基于每年最低血红蛋白的大红细胞（>100fL）或小红细胞（<80fL）贫血。使用具有稳健方差和一般估计方程的泊松回归模型来估计粗和经调整的患病率比率以及大红细胞风险因素的95％置信区间（与正常细胞)和微细胞(vs.正常细胞）贫血。
结果：在14,590PWH中确定贫血的37,984项血红蛋白测量中，27,909（74％）为正常细胞，4257（11%）为小细胞，5818（15％）是大细胞。在研究期间包括的贫血PWH中，1910（13％）经历了至少一种小细胞性贫血的测量，3208（22％）经历了至少一种大细胞性贫血的测量。正常细胞性贫血在男性和女性中最常见，其次是雌性的小细胞和雄性的大细胞。随着时间的推移,贫血的PWH中，大细胞增多的比例降低，而小细胞增多。大细胞（vs.正常细胞）贫血与年龄增加和合并症有关。随着年龄的增长,小红细胞性贫血在女性中有所减少，但男性没有。正常细胞性贫血的PWH中CD4计数≤200个细胞/mm3的比例更高，并且最近开始了ART。
结论：在贫血PWH中，正常细胞性贫血是最常见的。随着时间的推移，大细胞性贫血减少，和小红细胞性贫血增加不分性别。正常细胞性贫血通常是由于慢性疾病，并且可以解释在CD4计数较低或最近开始ART的人群中，正常细胞性贫血的风险更大。确定类型特异性贫血的风险因素，包括性别，年龄,合并症,和艾滋病毒因素，可以帮助有针对性地调查根本原因。
