Resolution of anaemia in a cohort of HIV-infected patients with a high prevalence and incidence of tuberculosis receiving antiretroviral therapy in South Africa.
Resolution of anaemia in a cohort of HIV-infected patients with a high prevalence and incidence of tuberculosis receiving antiretroviral therapy in South Africa.
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DOI：
10.1186/s12879-014-0702-1
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发表时间：
2014-12-21
影响因子：
3.7
通讯作者：
Lawn SD
中科院分区：
文献类型：
--
作者：
Kerkhoff AD;Wood R;Cobelens FG;Gupta-Wright A;Bekker LG;Lawn SD
在撒哈拉以南非洲，贫血通常与艾滋病毒感染和艾滋病毒相关结核病（TB）有关，并且与预后不良密切相关。然而，抗逆转录病毒疗法对结核病流行率和发病率高的患者队列中贫血消退的影响尚未完全确定，结核病发作对血红蛋白恢复的影响以前也没有报道。因此，我们使用来自南非开始ART的患者的良好特征队列的数据来研究这些问题。回顾性分析了在南非乡镇ART服务中接受ART的患者的临床和血液学数据。记录了结核病诊断和随时间更新的血红蛋白浓度、CD 4计数和艾滋病毒载量。根据WHO标准对贫血严重程度进行分类。多变量逻辑回归分析用于确定与ART治疗12个月后贫血独立相关的因素。在1，140例基线血红蛋白水平的患者中，814例在治疗中存活，并在ART治疗12个月后获得重复值。大多数患者为女性（73%），中位CD 4计数为104个细胞/uL，30.5%的患者在ART治疗的第一年诊断为TB。在基线时，574名（70.5%）患者存在贫血（任何严重程度），346名（42.5%）患者存在中度/重度贫血。ART治疗12个月后，218例（26.8%）患者出现任何严重程度的贫血，仅67例（8.2%）患者出现中度/重度贫血。ART治疗12个月后贫血的独立预测因素包括基线时贫血的严重程度、随时间更新的红细胞减少和接受含AZT的治疗方案。相比之下，流行和/或发病的结核病，性别和基线和时间更新的CD 4细胞计数和病毒载量测量不是独立的预测因子。虽然贫血在ART初治患者中非常常见，但在ART治疗的第一年，无论结核病状态如何，大多数患者的贫血都得到了解决，无需常规使用额外的干预措施。然而，大约四分之一的患者在接受抗逆转录病毒治疗一年后仍然贫血，可能需要额外的检查和/或干预。本文的在线版本（doi：10.1186/s12879-014-0702-1）包含补充材料，可供授权用户使用。
Anaemia is frequently associated with both HIV-infection and HIV-related tuberculosis (TB) in antiretroviral therapy (ART)-naïve patients in sub-Saharan Africa and is strongly associated with poor prognosis. However, the effect of ART on the resolution of anaemia in patient cohorts with a high prevalence and incidence of tuberculosis is incompletely defined and the impact of TB episodes on haemoglobin recovery has not previously been reported. We therefore examined these issues using data from a well-characterised cohort of patients initiating ART in South Africa. Prospectively collected clinical and haematological data were retrospectively analysed from patients receiving ART in a South African township ART service. TB diagnoses and time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded. Anaemia severity was classified according to WHO criteria. Multivariable logistic regression analysis was used to determine factors independently associated with anaemia after 12 months of ART. Of 1,140 patients with baseline haemoglobin levels, 814 were alive in care and had repeat values available after 12 months of ART. The majority of patients were female (73%), the median CD4 count was 104 cells/uL and 30.5% had a TB diagnosis in the first year of ART. At baseline, anaemia (any severity) was present in 574 (70.5%) patients and was moderate/severe in 346 (42.5%). After 12 months of ART, 218 (26.8%) patients had anaemia of any severity and just 67 (8.2%) patients had moderate/severe anaemia. Independent predictors of anaemia after 12 months of ART included greater severity of anaemia at baseline, time-updated erythrocyte microcytosis and receipt of an AZT-containing regimen. In contrast, prevalent and/or incident TB, gender and baseline and time-updated CD4 cell count and viral load measurements were not independent predictors. Although anaemia was very common among ART-naive patients, the anaemia resolved during the first year of ART in a large majority of patients regardless of TB status without routine use of additional interventions. However, approximately one-quarter of patients remained anaemic after one year of ART and may require additional investigations and/or interventions. The online version of this article (doi:10.1186/s12879-014-0702-1) contains supplementary material, which is available to authorized users.
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