Incidence and Risk Factors of Anemia after Initiation of ART among HIV-Infected Individuals in Taizhou

Li Chang; Xie Yali; Wang Shanling; Wang Tingting; Lin Haijiang; Chen Xiaoxiao; He Na

doi:10.3969/j.issn.1001-568X.2024.01.0019

Abstract：OBJECTIVE The study aimed to investigate the incidence and development of anemia in newly diagnosed HIV-in-fected individuals in Taizhou,Zhejiang province,from 2015 to 2019 after initiating antiretroviral therapy(ART)and its associated factors.METHODS A prospective cohort study was conducted,including HIV-infected individuals newly diagnosed between 2015 and 2019 and initiating ART.Cox proportional hazards model was used to analyze the incidence and worsening(defined as a de-crease in hemoglobin levels of 10g/L or greater from baseline)of anemia after initiating ART and its influencing factors.A mixed-ef-fects model was used to analyze the trend and related factors of hemoglobin changes over time after starting ART.RESULTS A total of 553 HIV-infected individuals were included in the analysis.The baseline prevalence of anemia was 21.2%(117/553).Among a baseline of 436 HIV-infected individuals without anemia,there was a total follow-up duration of 1 442.1 person-years,with an ane-mia incidence rate of 8.2 per 100 person-year.The results of the multivariate Cox regression analysis showed that the risk factors for anemia occurrence among HIV-infected individuals after initiating antiretroviral therapy(ART)were age≥60(aHR=3.71,95%CI:1.61～8.59,P=0.002),diabetes(aHR=1.79,95%CI:1.03～3.13,P=0.04),and the initial ART regimen containing zidovudine(ZDV)(aHR=3.16,95%CI:2.09～4.78,P＜0.01).For the baseline of 117 HIV-infected individuals with anemia,the total follow-up duration was 308.3 person-years,with an anemia worsening incidence rate of 9.1 per 100 person-years.The risk factor for worsening anemia was diabetes(aHR=2.68,95%CI:1.10～6.54,P=0.040).Female gender,diabetes,mild renal impairment,and cognitive dysfunction were associated with lower hemoglobin levels,and the use of ZDV in the initial ART regimen was associated with a declining trend in hemoglobin levels.CONCLUSION The incidence risk of anemia in HIV-infected individuals in Taizhou following the initiation of ART is higher among older age groups,those with diabetes,and individuals using zidovudine.Moreover,the risk of anemia worsen-ing is elevated in the subgroup of individuals with diabetes.Therefore,it is imperative to prioritize monitoring and implementing pre-ventive measures for anemia in these specific populations.