血液学状态可以预测开始高活性抗逆转录病毒治疗(HAART)的成年人的HIV疾病进展和死亡率。
我们旨在研究开始HAART时贫血和铁状态与生存和发病结局的关系。
我们进行了一项病例队列研究,研究对象为570名开始HAART的HIV感染成年人,他们在坦桑尼亚参加了一项多种维生素试验。血红蛋白,血清铁蛋白,在HAART开始时评估hepcidin浓度,并每月对参与者进行随访.我们使用回归校正方法调整血清铁蛋白以表征血液学状态。Cox比例风险模型用于估计死亡率和事件临床结果的HR。
我们发现83%的贫血患病率,缺铁性贫血的患病率为15%,慢性病贫血(ACD)患病率为66%。铁升高的患病率为33%,而铁缺乏(ID)的患病率为19%。经过多变量调整后,与非贫血参与者相比,重度贫血(HR:2.57;95%CI:1.49,4.45)和ACD(HR:4.71;95%CI:2.91,7.62)与死亡风险增加相关.此外,与正常铁浓度相比,ID(HR:2.65;95%CI:1.08,7.78)和铁升高(HR:2.83;95%CI:2.10,3.82)均与死亡风险增加相关.严重贫血和铁浓度升高与意外消瘦和>10%体重减轻相关(P值<0.05)。
在开始HAART的HIV感染成人中,贫血、ID和铁升高与死亡率增加相关。安全性和有效性研究,包括贫血病因,HAART启动的时机,在HIV患者中补充铁的剂量似乎是有必要的。该试验在clinicaltrials.gov注册为NCT00383669。
Hematological status may predict HIV disease progression and mortality among adults initiating highly active antiretroviral therapy (HAART).
We aimed to examine the relation of anemia and iron status at HAART initiation with survival and morbidity outcomes.
We conducted a case-cohort study of 570 HIV-infected adults initiating HAART who were enrolled in a trial of multivitamins in Tanzania. Hemoglobin, serum ferritin, and hepcidin concentrations were assessed at HAART initiation and participants were followed up monthly. We adjusted serum ferritin for inflammation using a regression correction method to characterize hematological status. Cox proportional hazards models were used to estimate HRs for mortality and incident clinical outcomes.
We found an 83% prevalence of anemia, 15% prevalence of iron deficiency anemia, and 66% prevalence of anemia of chronic diseases (ACD). The prevalence of elevated iron was 33% and 19% had iron deficiency (ID). After multivariate adjustment, severe anemia (HR: 2.57; 95% CI: 1.49, 4.45) and ACD (HR: 4.71; 95% CI: 2.91, 7.62) were associated with increased risk of mortality as compared with nonanemic participants. In addition, both ID (HR: 2.65; 95% CI: 1.08, 7.78) and elevated iron (HR: 2.83; 95% CI: 2.10, 3.82) were associated with increased risk of mortality as compared with normal iron concentrations. Severe anemia and elevated iron concentrations were associated with incident wasting and >10% weight loss (P values <0.05).
Anemia and both ID and elevated iron were associated with increased mortality among HIV-infected adults initiating HAART. Safety and efficacy studies including anemia etiology, timing of HAART initiation, and dose of iron supplementation among HIV patients appear warranted.This trial was registered at clinicaltrials.gov as NCT00383669.