Plasma hemoglobin and the risk of death in HIV/AIDS patients treated with antiretroviral therapy

Wang, Dayong; Hou, Xiangqing; Yu, Xianghua; Wang, Tao; Ye, Zhenmiao; Li, Jushuang; Su, Feifei; Guo, Chengnan; Peng, Fang; Zhao, Shuzhen; Li, Huihui; Zuo, Jingjing; Su, Dehua; Zhao, Lina; Zhang, Hemei; Chen, Xiangyang; Wang, Ruoqiu; Xie, Qipeng; Cheng, Zheng; Mao, Guangyun

doi:10.18632/aging.202987

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Therefore, the actual effect of anemia on the risk of death from PLWHA should be comprehensively assessed. Consistent with our results, two prior studies have reported that lower baseline plasma hemoglobin levels may be an independent marker of the risk of death in PLWHA ( 13 , 14 ). Another study indicated that anemia might be a predictor of AIDS-related mortality ( 23 ).…”

Section: Discussionsupporting

confidence: 93%

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Anemia is independently associated with mortality in people living with human immunodeficiency virus/acquired immune deficiency syndrome: A propensity score matching-based retrospective cohort study in China

Jin

Wang²,

Li³

et al. 2023

Front. Med.

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Although previous studies have suggested that hemoglobin is related to the health status of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA), the role of anemia in mortality remains unclear. This study aimed to comprehensively quantify the effect of anemia on the mortality risk of PLWHA. In this retrospective cohort study, we thoroughly estimated the effect of anemia on PLWHA mortality, using data collected from January 2005 to June 2022 in the Huzhou area, in 450 subjects extracted from the database of the China Disease Prevention and Control Information System and matched them using a propensity score matching approach to balance potential confounding bias. The potential exposure–response relationship between anemia, hemoglobin concentration, and the mortality of PLWHA was also carefully estimated. A series of subgroup analyses, including interaction analysis, was further conducted to validate the robustness of the effect of anemia on PLWHA death risk. Anemia was significantly associated with an elevated death risk in PLWHA, with an increase of 74% (adjusted hazard ratio [AHR]: 1.74; 95% confidence interval [CI]: 1.03–2.93; p = 0.038) in those with anemia after adjusting for potential confounders. PLWHA with moderate or severe anemia had a higher risk of death, with an 86% increase (AHR = 1.86; 95% CI: 1.01–3.42; p = 0.045). Meanwhile, the AHR tended to increase by 85% on average (AHR = 1.85, 95% CI: 1.37–2.50; p < 0.001) with a per standard deviation (SD) decrease in plasma hemoglobin. Consistent relationships between plasma hemoglobin and the risk of death were further observed in the results from multiple quantile regression models, restricted cubic spline regression models, and a series of subgroup analyses. Anemia is an independent risk factor for HIV/AIDS-related mortality. Our findings may provide new insights into the relevance of PLWHA administration to public health policy, which demonstrate that this low-cost and routinely measured marker (hemoglobin) can be a marker of poor prognosis even before the start of HAART.

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Section: Discussionsupporting

confidence: 93%

“…Although a series of previous studies have reported that plasma hemoglobin is associated with the health status of PLWHA, whether anemia plays an independent role in HIV/AIDS-related death remains unclear ( 13 – 16 ). This knowledge is valuable for the efficient prevention and control of HIV/AIDS in practice.…”

Section: Introductionmentioning

confidence: 99%

Anemia is independently associated with mortality in people living with human immunodeficiency virus/acquired immune deficiency syndrome: A propensity score matching-based retrospective cohort study in China

Jin

Wang²,

Li³

et al. 2023

Front. Med.

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“…[ 14,15 ] Moreover, available studies have revealed the immune proliferation, senescence, exhaustion, and percentages of regulatory T cells (Tregs) may also reflect the immune recovery. [ 16,17 ] The nutritional status, [ 18 ] such as body mass index (BMI), [ 19 ] hemoglobin (HB), [ 20 ] and other parameters, [ 18 ] has been widely used for the assessment of prognosis of HIV‐infected patients, but their roles in the assessment of immune recovery are still controversial. The immune reconstitution is also linked to viral co‐infection (such as hepatitis B virus [HBV], [ 21 ] hepatitis C virus [HCV], [ 22,23 ] and syphilis, [ 24 ] ) and the specific ART protocol.…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China

Wang,

Liu,

Zhang

et al. 2023

Advanced Biology

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This study aims to develop and evaluate a model to predict the immune reconstitution among HIV/AIDS patients after antiretroviral therapy (ART). A total of 502 HIV/AIDS patients are randomized to the training cohort and evaluation cohort. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis are performed to identify the indicators and establish the nomogram for predicting the immune reconstitution. Decision curve analysis (DCA) and clinical impact curve (CIC) are used to evaluate the clinical effectiveness of the nomogram. Predictive factors included white blood cells (WBC), baseline CD4+ T‐cell counts (baseline CD4), ratio of effector regulatory T cells to resting regulatory T cells (eTreg/rTreg) and low‐density lipoprotein cholesterol (LDL‐C) and are incorporated into the nomogram. The area under the curve (AUC) is 0.812 (95% CI, 0.767∼0.851) and 0.794 (95%CI, 0.719∼0.857) in the training cohort and evaluation cohort, respectively. The calibration curve shows a high consistency between the predicted and actual observations. Moreover, DCA and CIC indicate that the nomogram has a superior net benefit in predicting poor immune reconstitution. A simple‐to‐use nomogram containing four routinely collected variables is developed and internally evaluated and can be used to predict the poor immune reconstitution in HIV/AIDS patients after ART.

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“…Excessive progression of HIV leads to decreased of immune response [ 8 ] as well as blood hemoglobin levels [ 9 ] and substantially associated with decreased survival of patients. This indicated CD4 cell count and hemoglobin level are the greatest biological markers in HIV patients and independent indicators of survival time to default from ART treatment.…”

Section: Introductionmentioning

confidence: 99%

Predictors for CD4 cell count and hemoglobin level with survival time to default for HIV positive adults under ART treatment at University of Gondar Comprehensive and Specialized Hospital, Ethiopia

Muhie,

Tegegne

2023

BMC Res Notes

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Background HIV/AIDS is the most known powerful risk factor for morbidity and mortality in the world. The greatest biological markers in HIV patients are CD4 cell count and hemoglobin level, as they are independent predictors of survival of HIV patients. The objective of this study was to investigate the common socio-demographic, clinical, and behavioral Predictor’s affecting the CD4 cell count, and hemoglobin level with survival time to default from ART treatment among HIV positive adults under ART treatment at university of Gondar comprehensive and specialized hospital, North-west Ethiopia. Method This study was conducted at University of Gondar comprehensive specialized hospital by using a retrospective cohort follow up study design. The source of data in this study was secondary data obtained from patients chart. Bayesian joint models were employed to get wide-ranging information about HIV/AIDS progression. Result From a total of 403 HIV positive adults, about 44.2% were defaulted from therapy and the rest were actively followed ART treatment. The estimate of the association parameter for the current true value of CD4 cell count ($${\alpha }_{1}$$ α 1 ), and hemoglobin level ($${\alpha }_{2}$$ α 2 ), trend of CD4 cell count ($${\alpha }_{2}$$ α 2 ) and hemoglobin level ($${b}_{2}$$ b 2 ) is positive. Positive values indicating that the higher CD4 cell count and hemoglobin level is related with the higher time of defaulting from ART. Predictor’s hematocrit, weight, platelet cell count, lymphocyte count, sex, adherence, and WHO clinical stage were joint determinate risk factors affecting CD4 cell count, hemoglobin level and time to default at 5% level of significance. Conclusion Current study results revealed that hematocrit, weight, BMI, platelet cell count, lymphocyte count, sex (female), and good treatment adherence were significantly associated with higher CD4 cell count, hemoglobin level and time to default while having advanced WHO clinical stage-IV had significantly decreased CD4 cell, hemoglobin level, and time to default from treatment. Patients with HIV should be given special attention based on these important factors to improve their health and prolong their lives.

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Plasma hemoglobin and the risk of death in HIV/AIDS patients treated with antiretroviral therapy

Cited by 7 publications

References 22 publications

Anemia is independently associated with mortality in people living with human immunodeficiency virus/acquired immune deficiency syndrome: A propensity score matching-based retrospective cohort study in China

Anemia is independently associated with mortality in people living with human immunodeficiency virus/acquired immune deficiency syndrome: A propensity score matching-based retrospective cohort study in China

Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China

Predictors for CD4 cell count and hemoglobin level with survival time to default for HIV positive adults under ART treatment at University of Gondar Comprehensive and Specialized Hospital, Ethiopia

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