Differential prevalence and correlates of anemia among newly diagnosed versus formerly reported HIV-infected persons in Taizhou City
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摘要:
目的 通过比较台州市新确诊及既往HIV感染者影响因素差异，为进一步完善HIV感染者贫血防治措施提供科学依据。 方法 纳入浙江省台州市开展的台州HIV与衰老队列研究中2 756例HIV感染者，包括620名新确诊感染者及2 136名既往感染者。运用logistic回归分析模型分析并比较新确诊及既往HIV感染者贫血患病及影响因素。 结果 在接受调查的2 756例HIV感染者中，贫血患病率为18.7%(516/2 756)。其中新确诊的HIV感染者有620人，贫血患病率为23.6%(146/620)。既往感染者有2 136人，贫血患病率为17.3%(370/2 136)。多因素logistic回归分析模型分析结果显示，无论是新确诊感染者还是既往感染者，性别及CD4+T淋巴细胞(CD4细胞)均为贫血患病影响因素(P＜0.05)。除此之外，新确诊感染者中的影响因素还有过瘦(OR=2.88, 95% CI: 1.56~5.33, P=0.001)、超重或肥胖(OR=0.47, 95% CI: 0.28~0.81, P=0.006)、结核病史(OR=11.16, 95% CI: 1.55~80.27, P=0.017)、轻度肾功能不全(OR=1.87, 95% CI: 1.07~3.25, P=0.027)；既往感染者中的影响因素：年龄45~59岁(OR=2.05, 95% CI: 1.30~3.24, P=0.002)、年龄≥60岁(OR=3.48, 95% CI: 2.08~5.83, P＜0.001)、受教育水平为高中及以上(OR=0.62, 95% CI: 0.44~0.90, P=0.010)、患糖尿病(OR=1.60, 95% CI: 1.04~2.47, P=0.034)、患高胆固醇血症(OR=0.73, 95% CI: 0.55~0.96, P=0.023)。 结论 台州市HIV感染者贫血患病率相对于国内同期HIV感染者人群较低。除性别、CD4+T淋巴细胞细胞计数水平外，新确诊感染者与既往感染者贫血患病影响因素不同。因此，在贫血防治与筛查工作中应高度重视HIV感染者贫血的精准干预。 Abstract:Objective This study aims to explore and draw comparison in influencing factors between newly diagnosed and formerly reported HIV-infected persons in Taizhou City. The findings provide scientific evidence for improving preventative measures and treatment for anemia in HIV-infected individuals. Methods A total of 2 756 HIV-infected individuals from the Comparative HIV and aging research in Taizhou (CHART) were recruited in Taizhou, Zhejiang Province, include 620 newly diagnosed cases and 2 136 formerly reported cases. Logistic regression models were used to analyze the factors influencing anemia among HIV-infected individuals and draw comparion in influencing factors between newly diagnosed and formerly reported HIV-infected persons. Results Among the 2 756 HIV-infected individuals surveyed, the prevalence of anemia was 18.7% (516/2, 756). Among the 620 newly diagnosed HIV cases, the prevalence of anemia was 23.6% (146/620), while among the 2 136 formerly reported HIV cases, the prevalence of anemia was 17.3% (370/2 136). Multivariable logistic regression analysis showed that both newly diagnosed and previously infected individuals shared gender and CD4 count as influencing factors for anemia, in addition to which, among newly diagnosed cases, other influencing factors included underweight (OR=2.88, 95% CI: 1.56-5.33, P=0.001), overweight or obesity (OR=0.47, 95% CI: 0.28-0.81, P=0.006), history of tuberculosis (OR=11.16, 95% CI: 1.55-80.27, P=0.017), and mild renal insufficiency (OR=1.87, 95% CI: 1.07-3.25, P=0.027). Among Previously infected individuals, the influencing factors included the age group of 45-59 years (OR=2.05, 95% CI: 1.30~3.24, P=0.002), age ≥60 years (OR=3.48, 95% CI: 2.08~5.83, P<0.001), education level of high school or above (OR=0.62, 95% CI: 0.44-0.90, P=0.010), diabetes (OR=1.60, 95% CI: 1.04-2.47, P=0.034), and hypercholesterolemia (OR=0.73, 95% CI: 0.55-0.96, P=0.023). Conclusions The prevalence of anemia among HIV-infected individuals in Taizhou City is relatively lower compared to other HIV-infected populations in China during the same period. Aside from gender and CD4 cell count, newly diagnosed and formerly reported HIV cases differ in the factors influencing anemia. Therefore, precise interventions of anemia among HIV-infected individuals should be emphasized in the prevention, screening, and treatment of anemia. -
Key words:
- HIV /
- Anemia /
- Prevalence
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表 1 研究对象人群基本特征
Table 1. Basic characteristics of the research subjects
变量 Variable 总人数(占比/%)
Number of people (proportion/%)新确诊感染者①
Newly diagnosed HIV-infectedpeople① (n=620)既往感染者①
Formerly reported HIV-infected people① (n=2 136)χ2值
valueP值
value贫血 Anemia 是 Yes 516(18.7) 146(23.5) 370(17.3) 12.241 < 0.001 年龄组/岁 Age group/years 15~＜30 554(20.1) 146(23.6) 408(19.1) 15.811 0.001 30~＜45 902(32.7) 168(27.1) 734(34.4) 45~＜60 793(28.8) 175(28.2) 618(28.9) ≥60 507(18.4) 131(21.1) 376(17.6) 性别 Gender 男 Male 2 166(78.6) 495(79.8) 1 671(78.2) 0.739 0.390 受教育水平 Education level 初中及以下 Junior high school and below 1 970(71.5) 447(72.1) 1 523(71.3) 0.149 0.669 高中及以上 High school and above 786(28.5) 173(27.9) 613(28.7) 吸烟 Smoking 从不吸烟 Never 1 653(60.0) 348(56.2) 1 305(61.1) 5.310 0.070 曾经吸烟 Ever 337(12.2) 87(14.0) 250(11.7) 最近吸烟 Recent 766(27.8) 185(29.8) 581(27.2) 最近饮酒 Recent drinking 是 Yes 248(8.9) 45(7.3) 203(9.5) 2.959 0.085 吸毒史 History of drug use 是 Yes 49(1.8) 13(2.1) 36(1.7) 0.466 0.495 BMI 过瘦 Underweight 283(10.3) 67(10.8) 216(10.1) 2.287 0.319 正常 Normal 1 816(65.9) 393(63.4) 1 423(66.6) 超重或肥胖 Overweight or obesity 657(23.8) 160(25.8) 497(23.3) 高血压 Hypertension 是 Yes 609(22.1) 145(23.4) 464(21.7) 0.773 0.379 糖尿病 Diabetes 是 Yes 186(6.7) 58(9.4) 128(6.0) 8.632 0.003 肾功能不全 Renal insufficiency 无 No 1 971(71.5) 490(79.0) 1 481(69.3) 24.072 < 0.001 轻度 Mild 721(26.2) 115(18.6) 606(28.4) 中至重度 Moderate or severe 64(2.3) 15(2.4) 49(2.3) CD4/(counts·μL-1) <350 1 166(42.3) 411(66.3) 755(35.3) 189.38 < 0.001 病毒载量/(copies·mL-1) Viral load/(copies·mL-1) ① <50 1 857(86.9) — 1 857(86.9) — — ART治疗时长/年 Duration of ART treatment/years ① <1 738(34.5) — 738(34.5) — — 1~<5 884(41.4) — 884(41.4) — — ≥5 514(24.1) — 514(24.1) — — ART治疗方案 ② ART treatment regimen ② 含齐多夫定 Include zidovudine 1 210(56.6) — 1 210(56.6) — — 认知功能障碍 Cognition impairment 有 Yes 484(17.6) 73(11.8) 411(19.2) 18.630 < 0.001 结核病 Tuberculosis 有 Yes 35(1.3) 7(1.1) 28(1.3) 0.719 0.719 高胆固醇血症 Hypercholesterolemia 有 Yes 762(27.6) 93(15.0) 669(31.3) 63.980 < 0.001 高三酰甘油血症 Hypertriglyceridemia 有 Yes 1 334(48.4) 243(39.2) 1 045(48.9) 18.274 < 0.001 混合型高脂血症 Combined hyperlipidemia 有 Yes 289(10.5) 65(10.5) 224(10.5) < 0.001 0.998 低高密度脂蛋胆固醇血症 Low high-density lipoproteinemia 有 Yes 1 276(46.3) 371(59.8) 905(42.4) 59.984 < 0.001 注：1. ART，抗反转录病毒治疗。
2. “—”表示无数据。
①人数(占比/%)；②因新确诊HIV感染者尚未开始ART治疗，此变量数据缺失。
Note: 1. ART，antiretroviral therapy.
2. "—" indicates no date available.
① Number of people (proportion/%); ② Data for this variable were missing because newly diagnosed HIV-infected people had not yet started ART.
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表 2 新确诊HIV感染者贫血影响因素logistic回归分析模型分析
Table 2. Logistics regression analysis of factors influencing anemia in newly diagnosed HIV-infected persons
变量 Variable 总人数(患病率/%)
Total (prevalence/%)单因素分析
Univariate analysis多因素分析
Multivariate analysisOR值 value
(95% CI)P值
valueaOR值 value
(95% CI)P值
value年龄组/岁 Age group/years 15~＜30 146(14.3) 1.00 1.00 30~＜45 168(19.6) 1.45(0.80~2.64) 0.220 1.69(0.87~3.28) 0.125 45~＜60 175(23.4) 1.82(1.02~3.25) 0.043 1.19(0.59~2.39) 0.630 ≥60 131(38.9) 3.79(2.12~6.78) < 0.001 1.87(0.87~4.01) 0.110 性别 Gender 女 Female 125(38.4) 1.00 1.00 男 Male 495(19.7) 0.39(0.25~0.60) < 0.001 0.41(0.24~0.71) 0.002 受教育水平 Education level 初中及以下 Junior high school and below 447(27.0) 1.00 1.00 高中及以上 High school and above 173(14.4) 0.45(0.28~0.73) 0.001 0.77(0.43~1.41) 0.402 吸烟 Smorking 从不 Never 348(25.0) 1.00 1.00 曾经 Ever 87(35.6) 1.66(1.00~2.74) 0.047 1.79(0.96~3.32) 0.065 最近 Recent 185(15.1) 0.53(0.33~0.85) 0.009 0.64(0.37~1.11) 0.111 最近饮酒 Recent drinking 否 No 575(24.5) 1.00 1.00 是 Yes 45(11.1) 0.38(0.14~0.99) 0.047 0.45(0.16~1.26) 0.127 吸毒史 History of drug use 否 No 607(23.5) 1.00 是 Yes 13(23.0) 0.97(0.26~3.58) 0.968 BMI 正常 Normal 393(23.6) 1.00 1.00 过瘦 Underweight 67(43.2) 2.46(1.44~4.21) < 0.001 2.88(1.56~5.33) 0.001 超重或肥胖 Overweight or obesity 160(15.0) 0.57(0.35~0.93) < 0.001 0.47(0.28~0.81) 0.006 高血压 Hypertension 否 No 475(24.4) 1.00 是 Yes 145(20.6) 0.80(0.51~1.27) 0.355 糖尿病 Diabetes 否 No 562(22.4) 1.00 1.00 是 Yes 58(34.4) 1.82(1.02~3.24) 0.042 1.53(0.78~3.00) 0.216 肾功能不全 Renal insufficiency 无 No 490(19.5) 1.00 1.00 轻度 Mild 115(38.2) 2.54(1.64~3.93) < 0.001 1.87(1.07~3.25) 0.027 中至重度 Moderate or severe 15(40.0) 2.73(0.95~7.87) 0.062 1.25(0.37~4.25) 0.720 CD4/(counts·μL-1) ≥350 411(28.6) 1.00 1.00 <350 209(13.9) 2.49(1.59~3.89) < 0.001 2.34(1.43~3.82) 0.001 认知功能障碍 Cognition impairment 无 No 547(21.7) 1.00 1.00 有 Yes 73(38.4) 2.24(1.34~3.75) 0.002 1.18(0.61~2.27) 0.620 结核病 Tuberculosis 无 No 613(23.1) 1.00 1.00 有 Yes 7(71.4) 8.31(1.60~43.29) 0.012 11.16(1.55~80.27) 0.017 高胆固醇血症 Hypercholesterolemia 无 No 527(24.3) 1.00 有 Yes 93(19.4) 0.74(0.43~1.29) 0.431 高三酰甘油血症 Hypertriglyceridemia 无 No 377(23.3) 1.00 有 Yes 243(23.9) 1.03(0.70~1.50) 0.705 混合型高脂血症 Combined hyperlipidemia 无 No 555(24.0) 1.00 有 Yes 65(20.0) 0.79(0.41~1.50) 0.419 低高密度脂蛋白胆固醇血症 Low high-density lipoproteinemia 无 No 249(20.9) 1.00 有 Yes 371(25.3) 1.28(0.87~1.88) 0.875
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表 3 既往HIV感染者贫血影响因素logistics回归分析模型分析
Table 3. Logistics regression analysis of factors influencing anemia in formerly reported HIV-infected persons
变量 Variable 总人数(患病率/%)
Total (prevalence/%)单因素分析
Univariate analysis多因素分析
Multivariate analysisOR值 value
(95% CI)P值
valueaOR值 value
(95% CI)P值
value年龄组/岁 Age group/years 15~＜30 408(8.57) 1.00 1.00 30~＜45 734(11.9) 1.45(0.96~2.19) 0.076 1.15(0.74~1.78) 0.550 45~＜60 618(20.7) 2.78(1.87~4.14) < 0.001 2.05(1.30~3.24) 0.002 ≥60 376(31.6) 4.93(3.27~7.42) < 0.001 3.48(2.08~5.83) < 0.001 性别 Gender 女 Female 465(27.9) 1.00 1.00 男 Male 1 671(14.3) 0.43(0.33~0.55) < 0.001 0.42(0.32~0.57) < 0.001 受教育水平 Education level 初中及以下 Junior high school and below 1 523(20.9) 1.00 1.00 高中及以上 High school and above 613(8.3) 0.34(0.25~0.46) < 0.001 0.62(0.44~0.90) 0.010 吸烟 Tobacco use 从不 Never 1 305(17.9) 1.00 1.00 曾经 Ever 250(19.6) 1.11(0.79~1.57) 0.531 1.79(0.96~3.32) 0.987 最近 Recent 581(14.9) 0.80(0.61~1.05) 0.115 0.91(0.67~1.24) 0.536 最近饮酒 Recent alcohol use 否 No 1 933(17.4) 1.00 是 Yes 203(16.7) 0.95(0.65~1.40) 0.821 吸毒史 History of drug use 否 No 2 100(17.4) 1.00 是 Yes 36(11.1) 0.59(0.20~1.68) 0.326 BMI 过瘦 Underweight 216(20.8) 1.00 1.00 正常 Normal 1 423(17.7) 1.22(0.85~1.74) 0.267 2.88(1.56~5.33) 0.520 超重或肥胖 Overweight or obesity 497(14.6) 0.80(0.60~1.06) 0.123 0.75(0.55~1.02) 0.066 高血压 Hypertension 否 No 1 672(16.5) 1.00 1.00 是 Yes 464(20.4) 1.31(1.01~1.69) 0.043 0.96(0.72~1.28) 0.760 糖尿病 Diabetes 否 No 2 008(16.6) 1.00 1.00 是 Yes 128(28.1) 1.96(1.31~2.93) 0.001 1.60(1.04~2.47) 0.034 肾功能不全 Renal insufficiency 无 No 1 481(15.0) 1.00 1.00 轻度 Mild 606(21.1) 1.51(1.18~1.92) 0.001 0.95(0.72~1.25) 0.688 中至重度 Moderate or severe 49(38.7) 3.57(1.97~6.45) < 0.001 1.71(0.90~3.28) 0.104 CD4/(counts·μL-1) ≥350 1 381(14.4) 1.00 1.00 <350 755(22.7) 1.74(1.39~2.18) < 0.001 1.54(1.20~1.96) 0.001 病毒载量 Viral load/(copies·mL-1) <50 1 857(17.0) 1.00 ≥50 279(18.9) 1.13(0.82~1.57) 0.428 ART治疗时长/年 Duration of ART treatments/years <1 738(17.9) 1.00 1~<5 884(16.3) 0.89(0.69~1.16) 0.394 ≥5 514(18.3) 1.03(0.77~1.38) 0.856 ART治疗方案 ART treatment regimen 不含齐多夫定 Not include zidovudine 926(16.2) 1.00 含齐多夫定 Include zidovudine 1 210(18.2) 1.13(0.90~1.43) 0.266 认知功能障碍 Cognition impairment 无 No 1 725(15.4) 1.00 1.00 有 Yes 411(25.5) 1.89(1.46~2.45) < 0.001 0.981(0.73~1.32) 0.898 结核病 Tuberculosis 无 No 2 108(17.2) 1.00 1.00 有 Yes 28(28.5) 1.93(0.84~4.41) 0.120 1.45(0.59~3.56) 0.412 高胆固醇血症 Hypercholesterolemia 无 No 1 467(21.0) 1.00 1.00 有 Yes 669(9.11) 0.81(0.63~1.04) 0.113 0.73(0.55~0.96) 0.023 高三酰甘油血症 Hypertriglyceridemia 无 No 1 091(19.0) 1.00 1.00 有 Yes 1 045(15.6) 0.78(0.63~0.98) 0.040 0.93(0.72~1.20) 0.575 混合型高脂血症 Combined hyperlipidemia 无 No 1 912(17.4) 1.00 有 Yes 224(16.0) 0.83(0.57~1.23) 0.371 低高密度脂蛋白胆固醇血症 Low high-density lipoproteinemia 无 No 1 231(16.7) 1.00 有 Yes 905(18.1) 1.10(0.87~1.38) 0.403 注：ART，抗反转录病毒治疗。
Note: ART，antiretroviral therapy.
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