Research Paper|Volume 13, Issue 9|pp 13061—13072

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

Dayong Wang^1,², Xiangqing Hou^2,³, Xianghua Yu¹, Tao Wang^2,⁴, Zhenmiao Ye¹, Jushuang Li^2,⁴, Feifei Su⁵, Chengnan Guo^2,⁴, Fang Peng^2,⁴, Shuzhen Zhao^2,⁴, Huihui Li^2,⁴, Jingjing Zuo⁶, Dehua Su¹, Lina Zhao¹, Hemei Zhang¹, Xiangyang Chen¹, Ruoqiu Wang¹, Qipeng Xie⁷, Chao Zheng⁸, Guangyun Mao^2,^4,⁶

¹Wenzhou Center for Disease Control and Prevention, Wenzhou 325000, Zhejiang, China
²Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, Zhejiang, China
³Faculty of Health Sciences, University of Macau, Macau 999078, China
⁴Center on Evidence-Based Medicine and Clinical Epidemiology, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, Zhejiang, China
⁵The Sixth People's Hospital of Wenzhou, Wenzhou 325035, Zhejiang, China
⁶School of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
⁷The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
⁸The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China

* Equal contribution

Received: August 28, 2020Accepted: March 26, 2021Published: May 7, 2021

https://doi.org/10.18632/aging.202987

Copyright: © 2021 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Previous studies concerning the effect of plasma hemoglobin (HB) and other factors that may modify the risk of death in people living with HIV/AIDS (PLHIV) treated with antiretroviral therapy (ART) are limited.

Results: Higher HB was independently linked to a lower death risk in PLHIV, with a decrease of 29% (13%, 43%) per standard deviation (SD) increment after adjusting for CD4, VL and other potential factors [hazard ratio (HR): 0.71, 95% confidence interval (CI): 0.57-0.87, P<0.001]. In addition, the addition of HB to the predictive model containing VL and CD4 significantly improved the C-index, by 0.69% (95% CI: 0.68%-0.71%), and net discrimination, by 0.5% (95% CI: 0.0%-1.6%, P=0.040), when predicting the death risk of PLHIV.

Conclusions: A lower level of HB was an independent risk factor for HIV/AIDS-associated death in PLHIV. HB combined with VL and CD4 may be an appropriate predictive model of the death risk of PLHIV.

Materials and methods: A propensity-score matching (PSM) approach was applied to select a total of 750 PLHIV (150 deceased and 600 living) from the AIDS prevention and control information system in the Wenzhou area from 2006 to 2018. Multivariable Cox proportional hazards regression models were formulated to estimate the effect of HB. The predictive performance improvement contributed by HB was evaluated using the C-index and net reclassification improvement.