| 姚仕堂,何春燕,曹东冬,章银娣,时允,肖桂芳,李品银,许元武,魏华,孙进廷,叶润华,杨跃诚,王继宝,何纳,丁盈盈,段松.云南省德宏傣族景颇族自治州2004-2018年启动抗病毒治疗后HIV/AIDS贫血发病及危险因素回顾性队列研究[J].Chinese journal of Epidemiology,2021,42(7):1218-1224 |
| 云南省德宏傣族景颇族自治州2004-2018年启动抗病毒治疗后HIV/AIDS贫血发病及危险因素回顾性队列研究 |
| A retrospective cohort study of incidence of anemia and risk factors in HIV/AIDS patients with access to antiretroviral therapy in Dehong Jingpo and Dai Autonomous Prefecture in Yunnan province, 2004-2018 |
| Received:June 02, 2020 |
| DOI：10.3760/cma.j.cn112338-20200602-00799 |
| KeyWord: HIV/AIDS 贫血 发病 危险因素 |
| English Key Word: HIV/AIDS Anemia Incidence Risk factors |
| FundProject:国家科技重大专项（2018ZX10715006-001，2018ZX10721102-004） |
| Author Name | Affiliation | E-mail | | Yao Shitang | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | | He Chunyan | Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China | | | Cao Dongdong | Dehong Dai and Jingpo Autonomous Prefecture People's Hospital, Mangshi 678400, China | | | Zhang Yindi | Dehong Dai and Jingpo Autonomous Prefecture People's Hospital, Mangshi 678400, China | | | Shi Yun | Mangshi City People's Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Mangshi 678400, China | | | Xiao Guifang | Traditional Chinese Medicine Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Mangshi 678400, China | | | Li Pinyin | Ruili City People's Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Ruili 678600, China | | | Xu Yuanwu | Longchuan County People's Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Longchuan 678700, China | | | Wei Hua | Yingjiang County People's Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Yingjiang 679300, China | | | Sun Jinting | Lianghe County People's Hospital of Dehong Dai and Jingpo Autonomous Prefecture, Lianghe 679200, China | | | Ye Runhua | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | | Yang Yuecheng | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | | Wang Jibao | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | | | He Na | Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China | | | Ding Yingying | Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China | dingyy@fudan.edu.cn | | Duan Song | Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China | |
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| Abstract: |
| 目的 了解德宏傣族景颇族自治州（德宏州）2004-2018年启动抗病毒治疗（ART）后HIV/AIDS贫血发病及其影响因素。方法 采用回顾性队列研究的方法，基于德宏州HIV/AIDS的ART数据库，纳入分析2004-2018年启动ART的HIV/AIDS。采用Cox比例风险模型分析启动ART后HIV/AIDS贫血和中重度贫血新发及其影响因素，用分段混合线性效应模型拟合基线不同贫血状况随访血红蛋白的变化轨迹。结果 共8 044例HIV/AIDS纳入分析。基线未患贫血者占78.8%（6 337/8 044）。6 337例基线未患贫血的HIV/AIDS中位随访时间为4.43（P25，P75：1.50，6.71）年，其中1 291例新发贫血和293例新发中重度贫血HIV/AIDS的中位随访时间分别为0.16（P25，P75：0.07，1.99）年、0.48（P25，P75：0.09，2.97）年，贫血和中重度贫血的发病密度分别为4.40/100人年、0.41/100人年。多因素Cox回归结果显示，启动ART后HIV/AIDS发生贫血的危险因素有年龄大、女性、傣族和景颇族、基线BMI<18.5 kg/m2、基线CD4+T淋巴细胞计数（CD4）<200个/μl、初始ART方案使用齐多夫定（AZT），发生中重度贫血的危险因素有女性、傣族、基线BMI<18.5 kg/m2、基线轻度贫血、初始ART方案使用AZT。结论 2004-2018年德宏州HIV/AIDS启动ART后贫血的发病风险在某些特征人群中较高，如≥ 60岁老年人、女性、少数民族、BMI偏低、基线CD4<200个/μl、ART方案使用AZT者。应重点加强对这部分人群贫血的筛查及其防治措施。 |
| English Abstract: |
| Objective To investigate the incidence of anemia and risk factors in HIV/AIDS patients with access to antiretroviral therapy (ART) during 2004-2018 in Dehong Jingpo and Dai Autonomous Prefecture (Dehong). Methods A retrospective cohort study was conducted in HIV/AIDS patients receiving ART in Dehong during 2004-2018 based on the data extracted from the National HIV/AIDS antiretroviral therapy database. Cox proportional risk model was used to analyze the factors associated with the incidences of anemia and moderate or severe anemia in the HIV/AIDS patients. And the piecewise linear mixed-effects model was used to depict the trajectory of hemoglobin changes over time after initiating ART according to baseline level. Results A total of 8 044 HIV/AIDS patients were included, in whom 6 337 (78.8%) were without anemia at baseline survey and had a median follow up time of 4.43 (P25, P75:1.50, 6.71) years. The median follow up time for 1 291 new anemia cases and 293 new moderate or severe anemia cases was 0.16 (P25, P75:0.07, 1.99) years and 0.48 (P25, P75:0.09, 2.97) years, respectively. The incidence rate of anemia and moderate or severe anemia was 4.40 per 100 person-years and 0.41 per 100 person-years respectively. In multivariable Cox regression analysis, older age, being female, being in Dai and Jingpo ethnic group, baseline BMI <18.5 kg/m2, baseline CD4+T lymphocyte cell counts (CD4) <200 cells/μl, and zidovudine (AZT) -based initial treatment regimen were factors significantly and positively associated with incidence of anemia after treatment. Factors as being female, being in Dai ethnic group, baseline BMI <18.5 kg/m2, mild baseline anemia, and AZT-based initial treatment regimen were significantly and positively associated with incidence of moderate or severe anemia after treatment. Conclusion The risk for anemia was higher in HIV/AIDS patients with specific characteristics, such as age ≥ 60 years, being female, being in Dai and Jingpo ethnic groups, lower BMI, CD4 <200 cells/μl, and treatment of AZT, after initiation of ART in Dehong during 2004-2018. Additional efforts are needed to strengthen the screening, prevention and treatment of anemia in this population. |
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