Analysis of the incidence of anemia and related risk factors in 878 AIDS patients with tuberculosis

doi:10.19982/j.issn.1000-6621.20260093

Abstract

Abstract:

Objective: To analyze the incidence and influencing factors of anemia in AIDS patients with tuberculosis in Henan Province. Methods: The clinical data of 878 patients with AIDS complicated by tuberculosis who were hospitalized in Henan Provincial Infectious Disease Hospital from January 2021 to November 2025 were retrospectively collected. The incidence of anemia and its influencing factors were analyzed. Results: The incidence of anemia among the 878 AIDS patients with tuberculosis in Henan Province was 61.39% (539/878). The results of multivariate logistic analysis showed that patients with extrapulmonary tuberculosis (OR=0.640, 95%CI: 0.432-0.947), antituberculosis treatment course of 6-24 months (OR=0.605, 95%CI: 0.428-0.855), or a CD4⁺ T-cell count >200 cells/μl (201-349 cells/μl: OR=0.320, 95%CI: 0.216-0.474; 350-499 cells/μl: OR=0.159, 95%CI: 0.094-0.272; ≥500 cells/μl: OR=0.051, 95%CI: 0.021-0.122) had a lower risk of anemia. Conclusion: The proportion of anemia in AIDS patients with tuberculosis in Henan Province is high. It is necessary to focus on patients with pulmonary tuberculosis, antituberculosis treatment course <6 months, and CD4⁺ T cell count ≤200/μl, so as to formulate and implement scientific and reasonable intervention measures to reduce the incidence of anemia risk.

Key words: Acquired immunodeficiency syndrome, Tuberculosis, Anemia, Comorbidity, Factor analysis, statistical

CLC Number:

R521

Zhang Aihua, Xu Meng, Yang Yuying, Su Shuang, Song Lei, Ma Dandan, Wei Suxia, Cheng Junwei, Fu Chaohong. Analysis of the incidence of anemia and related risk factors in 878 AIDS patients with tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(9): 1307-1314. doi: 10.19982/j.issn.1000-6621.20260093

Figures/Tables 4

References 52

[1]	Day J H, Grant A D, Fielding K L, et al. Does tuberculosis increase HIV load?[J]. J Infect Dis, 2004, 190(9):1677-1684. doi:10.1086/424851.
[2]	Burke R M, Sabet N, Ellis J, et al. Causes of hospitalisation among people living with HIV worldwide, 2014-23: a systematic review and meta-analysis[J]. Lancet HIV, 2025, 12(5):e355-e366. doi:10.1016/S2352-3018(24)00347-3.
[3]	Joint United Nations Programme on HIV/AIDS. UNAIDS Global AIDS Update 2025: AIDS, Crisis and the Power to Transform[R]. Geneva: Joint United Nations Programme on HIV/AIDS, 2025.
[4]	毛琛, 王岚, 李立明. 我国流行病学学科发展70年的历程与成就[J]. 中华流行病学杂志, 2019, 40(10):1173-1179. doi:10.3760/cma.j.issn.0254-6450.2019.10.001.
[5]	World Health Organization. Global Tuberculosis Report 2025[R]. Geneva: World Health Organization, 2025.
[6]	郑志刚, 耿文奎, 陆珍珍, 等. 艾滋病病毒与结核分枝杆菌双重感染对死亡的影响[J]. 中华流行病学杂志, 2018, 39(10):1362-1367. doi:10.3760/cma.j.issn.0254-6450.2018.10.014.
[7]	Abioye A I, Andersen C T, Sudfeld C R, et al. Anemia, Iron Status, and HIV: A Systematic Review of the Evidence[J]. Adv Nutr, 2020, 11(5):1334-1363. doi:10.1093/advances/nmaa037.
[8]	Araújo-Pereira M, Krishnan S, Salgame P, et al. Effect of the relationship between anaemia and systemic inflammation on the risk of incident tuberculosis and death in people with advanced HIV: a sub-analysis of the REMEMBER trial[J]. EClinical Medicine, 2023, 60:102030. doi:10.1016/j.eclinm.2023.102030.
[9]	刘言文, 许英明, 张由群, 等. 贫血与类风湿关节炎的关联:一项横断面和孟德尔随机化研究[J]. 细胞与分子免疫学杂志, 2026, 42(4):325-331. doi:10.13423/j.cnki.cjcmi.010103.
[10]	Ashenafi S, Bekele A, Aseffa G, et al. Anemia Is a Strong Predictor of Wasting, Disease Severity, and Progression, in Clinical Tuberculosis (TB)[J]. Nutrients, 2022, 14(16):3318. doi:10.3390/nu14163318.
[11]	林婧, 冯立慧, 李燕秋, 等. HIV/AIDS患者贫血、贫血加重的影响因素及其对预后的影响--一项回顾性队列研究[J]. 现代预防医学, 2025, 52(19):3496-3502. doi:10.20043/j.cnki.MPM.202503554.
[12]	陈露露, 骆梦醒, 邹欣, 等. 老年肺结核合并贫血患者的临床特征及抗结核疗效分析[J]. 中国防痨杂志, 2025, 47(10):1350-1357. doi:10.19982/j.issn.1000-6621.20250133.
[13]	Kamvuma K, Hamooya B M, Chiyenu K O R, et al. Sex differences in the risk profiles for anemia in people living with HIV, A cross sectional study[J]. PLoS One, 2025, 20(3):e319611. doi:10.1371/journal.pone.0319611.
[14]	Braat S, Fielding K L, Han J, et al. Haemoglobin thresholds to define anaemia from age 6 months to 65 years: estimates from international data sources[J]. Lancet Haematol, 2024, 11(4):e253-e264. doi:10.1016/S2352-3026(24)00030-9.
[15]	Cao G, Wang Y, Wu Y, et al. Prevalence of anemia among people living with HIV: A systematic review and meta-analysis[J]. EClinicalMedicine, 2022, 44:101283. doi:10.1016/j.eclinm.2022.101283.
[16]	中华人民共和国国家卫生和计划生育委员会. WS 196-2017结核病分类[J]. 结核与肺部疾病杂志, 2024, 5(4):379-380. doi:10.19983/j.issn.2096-8493.2024055.
[17]	中华人民共和国国家卫生和计划生育委员会. WS 288-2017肺结核诊断[J]. 结核与肺部疾病杂志, 2024, 5(4):376-378. doi:10.19983/j.issn.2096-8493.2024022.
[18]	中华医学会感染病学分会艾滋病学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2024版)[J]. 协和医学杂志, 2024, 15(6):1261-1288. doi:10.12290/xhyxzz.2024-0766.
[19]	周芸. 临床营养学[M]. 第5版. 北京: 人民卫生出版社, 2022.
[20]	Demitto F O, Araújo-Pereira M, Schmaltz C A, et al. Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV[J]. Front Immunol, 2020, 11:588405. doi:10.3389/fimmu.2020.588405.
[21]	Araújo-Pereira M, Barreto-Duarte B, Arriaga M B, et al. Relationship Between Anemia and Systemic Inflammation in People Living With HIV and Tuberculosis: A Sub-Analysis of the CADIRIS Clinical Trial[J]. Front Immunol, 2022, 13:916216. doi:10.3389/fimmu.2022.916216.
[22]	Araújo-Pereira M, Nogueira B M F, Spener-Gomes R, et al. Anemia and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis: A multi-center prospective cohort study[J]. J Infect Public Health, 2023, 16(6):974-980. doi:10.1016/j.jiph.2023.04.009.
[23]	Luo M, Liu M, Wu X, et al. Impact of anemia on prognosis in tuberculosis patients[J]. Ann Transl Med, 2022, 10(6):329. doi:10.21037/atm-22-679. pmid: 35433932
[24]	Han C, Fang Y, Dong L, et al. Correlation of tuberculosis-related anemia severity with tuberculosis-induced inflammation in children: a six-year retrospective study[J]. Ital J Pediatr, 2024, 50(1):116. doi:10.1186/s13052-024-01664-3. pmid: 38886797
[25]	Araújo-Pereira M, Schutz C, Barreto-Duarte B, et al. Interplay between systemic inflammation, anemia, and mycobacterial dissemination and its impact on mortality in TB-associated HIV: a prospective cohort study[J]. Front Immunol, 2023, 14:1177432. doi:10.3389/fimmu.2023.1177432.
[26]	Noor R A, Abioye A I, Hertzmark E, et al. Impaired Hematological Status Increases the Risk of Mortality among HIV-Infected Adults Initiating Antiretroviral Therapy in Tanzania[J]. J Nutr, 2020, 150(9):2375-2382. doi:10.1093/jn/nxaa172.
[27]	Hardang I M, Lilleholt K, Hagve T A. Anemi ved kronisk sykdom [Anemia of chronic disease][J]. Tidsskr Nor Laegeforen, 2017, 137(17). doi:10.4045/tidsskr.16.1128.
[28]	中华医学会结核病学分会重症专业委员会. 结核病营养治疗专家共识[J]. 中华结核和呼吸杂志, 2020, 43(1):17-26. doi:10.3760/cma.j.issn.1001-0939.2020.01.006.
[29]	Meintjes G, Maartens G. HIV-Associated Tuberculosis[J]. N Engl J Med, 2024, 391(4):343-355. doi:10.1056/NEJMra2308181.
[30]	Sadiq S, Khajuria V, Tandon V R, et al. Adverse Drug Reaction Profile in Patients on Anti-tubercular Treatment Alone and in Combination with Highly Active Antiretroviral Therapy[J]. J Clin Diagn Res, 2015, 9(10):FC01-FC04. doi:10.7860/JCDR/2015/13452.6652.
[31]	Cossarizza A, Chang H D, Radbruch A, et al. Guidelines for the use of flow cytometry and cell sorting in immunological studies (second edition)[J]. Eur J Immunol, 2019, 49(10):1457-1973. doi:10.1002/eji.201970107.
[32]	Iglesias J, Ledesma K J, Couto P J, et al. Immune Reconstitution Inflammatory Syndrome Occurring in a Kidney Transplant Patient with Extrapulmonary Tuberculosis[J]. Case Rep Transplant, 2017, 2017:6290987. doi:10.1155/2017/6290987.
[33]	廖艳研. HIV/Mtb合并感染的疾病进展分析及SOCS-TLRs信号轴在HIV促进Mtb感染中的作用研究[D]. 南宁: 广西医科大学, 2021.
[34]	樊红丽, 谢祺, 李健健, 等. HIV/AIDS合并结核感染患者贫血情况及其与CD4⁺ T淋巴细胞计数和BMI指数相关性分析[J]. 临床医学进展, 2025, 15(7):441-448. doi:10.12677/acm.2025.1572007.
[35]	Chhabra S, Kashyap A, Bhagat M, et al. Anemia and Nutritional Status in Tuberculosis Patients[J]. Int J Appl Basic Med Res, 2021, 11(4):226-230. doi:10.4103/ijabmr.ijabmr_76_21. pmid: 34912685
[36]	Dasaradhan T, Koneti J, Kalluru R, et al. Tuberculosis-Associated Anemia:A Narrative Review[J]. Cureus, 2022, 14(8):e27746. doi:10.7759/cureus.27746.
[37]	齐畅, 蒋波笛, 付晨珺, 等. 贫血对肺结核患者转归的影响[J]. 临床输血与检验, 2026, 28(1):111-121. doi:10.3969/j.issn.1671-2587.2026.01.017.
[38]	马锡慧, 李彬钰, 韩永, 等. 结核病患者外周血淋巴细胞亚群以及12项血浆细胞因子流式检测分析[J]. 中华检验医学杂志, 2024, 47(7):755-762. doi:10.3760/cma.j.cn114452-20240109-00014.
[39]	牛佩璇. 2018-2022年肺外结核住院患者流行病学及临床特征分析[D]. 乌鲁木齐: 新疆医科大学, 2024. doi:10.27433/d.cnki.gxyku.2024.000397.
[40]	de Mendonça E B, Schmaltz C A, Sant’Anna F M, et al. Anemia in tuberculosis cases: A biomarker of severity?[J]. PLoS One, 2021, 16(2):e245458. doi:10.1371/journal.pone.0245458.
[41]	Sabzi F, Faraji R, Khoshnood S. Clinical symptoms, pathogenesis and postoperative course of non-specific constrictive pericarditis with dumbbell-shaped heart[J]. GMS Hyg Infect Control, 2024, 19:Doc08. doi:10.3205/dgkh000463.
[42]	谢贝, 许婉华, 龚兰, 等. 肺结核治疗过程中IL-6血清表达水平变化分析[J]. 实用医学杂志, 2023, 39(19):2434-2439. doi:10.3969/j.issn.1006-5725.2023.19.004.
[43]	彭琰淇, 杨丹丹, 李林宏, 等. 铁生物标志物在人类免疫缺陷病毒/结核分枝杆菌合并感染中的应用潜力[J]. 传染病信息, 2025, 38(3):295-300. doi:10.3969/j.issn.1007-8134.2025.03.017.
[44]	Nienaber A, Uyoga M A, Dolman-Macleod R C, et al. Iron Status and Supplementation during Tuberculosis[J]. Microorganisms, 2023, 11(3):785. doi:10.3390/microorganisms11030785.
[45]	李畅, 汪剡灵, 王婷婷, 等. 台州市新确诊及既往HIV感染者贫血患病情况差异研究[J]. 中华疾病控制杂志, 2024, 28(4):409-416. doi:10.16462/j.cnki.zhjbkz.2024.04.006.
[46]	Lang R, Gill M J, Coburn S B, et al. The changing prevalence of anemia and risk factors in people with HIV in North America who have initiated ART, 2007-2017[J]. AIDS, 2023, 37(2):287-298. doi:10.1097/QAD.0000000000003423. pmid: 36541641
[47]	张之, 孙琦, 邱涛, 等. 2021年江苏省新报告HIV/AIDS患者贫血发生率及其危险因素分析[J]. 中国血吸虫病防治杂志, 2024, 36(6):598-605. doi:10.16250/j.32.1915.2024174.
[48]	中国性病艾滋病防治协会HIV合并结核病专业委员会. HIV/AIDS患者合并结核病诊治专家共识(2025年版)[J]. 中国艾滋病性病, 2025, 31(11):1278-1286. doi:10.13419/j.cnki.aids.2025.11.20.
[49]	Obeagu E I, Obeagu G U, Ukibe N R, et al. Anemia, iron, and HIV: decoding the interconnected pathways: A review[J]. Medicine (Baltimore), 2024, 103(2):e36937. doi:10.1097/MD.0000000000036937.
[50]	Kamvuma K, Hamooya B M, Munsaka S, et al. Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV[J]. Viruses, 2024, 16(4):542. doi:10.3390/v16040542.
[51]	邹莉萍, 陈晴, 唐先珍, 等. 耐多药/利福平耐药结核病患者合并外周血CD4⁺ T淋巴细胞降低的临床特征及危险因素分析[J]. 中国热带医学, 2024, 24(5):537-541. doi:10.13604/j.cnki.46-1064/r.2024.05.07.
[52]	Mu Q, Chen L, Gao X, et al. The role of iron homeostasis in remodeling immune function and regulating inflammatory disease[J]. Sci Bull (Beijing), 2021, 66(17):1806-1816. doi:10.1016/j.scib.2021.02.010.

特征	例数(构成比,%)	特征	例数(构成比,%)
性别		有饮酒史	301(34.28)
男性	710(80.87)	居住地
女性	168(19.13)	农村	684(77.91)
年龄组(岁)		城市	183(20.84)
<40	343(39.07)	看守所	11(1.25)
40~60	400(45.56)	合并结核病类型
>60	135(15.37)	肺结核	444(50.57)
职业		肺外结核	175(19.93)
无业人员/离(退)休人员	107(12.19)	肺结核+肺外结核	259(29.50)
农民	491(55.92)	HIV感染确诊时长(月)
自由职业	178(20.27)	<6	273(31.09)
其他	102(11.62)	6~24	175(19.93)
婚姻状况		>24	430(48.98)
未婚	196(22.32)	抗结核疗程(月)
已婚	565(64.35)	<6	588(66.97)
离婚/丧偶	117(13.33)	6~24	215(24.49)
文化程度		>24	75(8.54)
文盲	67(7.63)	痰涂片/培养
小学	194(22.10)	阴性	665(75.74)
初中	358(40.77)	阳性	213(24.26)
中专/高中	139(15.83)	CD4⁺T细胞计数(个/μl)
大专及以上	120(13.67)	≤200	619(70.50)
医疗保障		201~349	131(14.92)
无	132(15.03)	350~499	75(8.54)
有	746(84.97)	≥500	53(6.04)
吸烟史		HIV-RNA定量(拷贝/ml)
从不吸烟	518(59.00)	≤1000	421(47.95)
有吸烟史	360(41.00)	1001~3000	31(3.53)
饮酒史		3001~5000	16(1.82)
从不饮酒	577(65.72)	>5000	410(46.70)

序号	变量	赋值
Y	贫血	无=0;有=1
X₁	居住地	农村=0;城市=1;看守所=2
X₂	痰涂片/培养	阴性=0;阳性=1
X₃	结核病类型	肺结核=0;肺外结核=1;肺结核+肺外结核=2
X₄	HIV感染确诊时长	<6个月=0;6~24个月=1;>24个月=2
X₅	抗结核疗程	<6个月=0;6~24个月=1;>24个月=2
X₆	CD4⁺T细胞计数	≤200个/μl=0;201~349个/μl=1;350~499个/μl=2;≥500个/μl=3

因素	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	P值	OR(95%CI)值
合并结核病类型
肺结核				0.045	1.000
肺外结核	-0.447	0.200	4.992	0.025	0.640(0.432~0.947)
肺结核+肺外结核	0.053	0.179	0.087	0.768	1.054(0.742~1.499)
抗结核疗程(月)
<6				0.015	1.000
6~24	-0.503	0.176	8.113	0.004	0.605(0.428~0.855)
>24	-0.280	0.278	1.016	0.313	0.756(0.439~1.302)
CD4⁺T细胞计数(个/μl)
≤200				<0.001	1.000
201~349	-1.140	0.200	32.401	<0.001	0.320(0.216~0.474)
350~499	-1.836	0.272	45.499	<0.001	0.159(0.094~0.272)
≥500	-2.976	0.447	44.409	<0.001	0.051(0.021~0.122)