Erythrocyte indices, anaemia levels and types in Kenyan injection and non-injection substance users

Abstract The impact of injection and non-injection substance use in HIV infections is an area of great public importance especially with respect to hematologic and immune profiles. Evaluations of hematologic and immune status are critical for better disease classification and clinical management especially of HIV positive substance users. However, not much information is known about the hematologic and immune derangements in HIV infected injection and non-injection substance users. This study, therefore, aimed at determining the laboratory markers of hematologic and immune derangements in HIV infected substance users. Hematologic and immune profiles were evaluated on venous blood specimens obtained from injection substance users, ISU (HIV-infected, n=62 and -uninfected, n=213) and non-injection substance users (HIV-infected, n=33 and -uninfected, n=186); and non-substance using controls (n=56) from Mombasa, coastal town of Kenya. The prevalence of anemia was higher in HIV infected ISU (48.4%) and non-ISU (63.6%) (p<0.0001); and HIV uninfected ISUs (56.3%) compared to HIV-uninfected non-ISUs (39.2%) and non-substance using controls (28.6%; p=0.0028). Hypochromic anaemia was more prevalent in the HIV-infected ISU (50.0%) and non-ISU (61.9%), and HIV-negative ISU (63.3%) relative to the HIV-negative non-ISU (39.7%) and non-substance using controls (56.3%; p=0.0007). Mild immunodeficiency dominated in the HIV infected individuals (HIV-infected ISU, 32.3% and non-ISU, 21.2%) versus HIV-uninfected ISU (16.9%); non-ISU (12.9%); and non-substance users (14.3%) while severe immunosuppression prevailed in HIV infected substance users (ISU, 14.5% and non-ISU, 15.2%) against HIV uninfected substance users (ISU, 5.2% and non-ISU, 3.8%); thus immunosuppression in substance users is aggravated with HIV infection. Moreover, drug-induced immunosuppression is associated with a higher likelihood of anaemia in HIV-uninfected substance users; ISU (OR=3.95, CI=1.934-8.077, p<0.0001) and non-ISU (OR=3.63, CI=1.571-8.39, p=0.003). Altogether, hypochromic anaemia, normochromic anaemia and CD4+ T-helper cytopenia are the most prevalent hemocytopenias in HIV infected and uninfected injection and non-injection substance users.

摘要 注射与非注射物质使用对HIV感染的影响是极具公共卫生重要性的研究领域，尤其聚焦于血液学与免疫学特征。对血液学及免疫状态的评估，对于优化HIV阳性物质使用人群的疾病分型与临床管理至关重要。然而，目前针对HIV感染的注射及非注射物质使用人群的血液学与免疫紊乱相关信息仍较为匮乏。因此，本研究旨在明确HIV感染的物质使用人群的血液学与免疫紊乱实验室标志物。本研究对来自肯尼亚滨海城市蒙巴萨的静脉血标本开展血液学与免疫学特征分析，研究对象包括：注射物质使用人群（Injection Substance Users, ISU），其中HIV感染者62例、未感染者213例；非注射物质使用人群，其中HIV感染者33例、未感染者186例；以及非物质使用对照组56例。

贫血患病率在HIV感染的ISU（48.4%）与非ISU（63.6%）中均显著升高（p<0.0001）；HIV未感染的ISU（56.3%）贫血患病率亦高于HIV未感染的非ISU（39.2%）与非物质使用对照组（28.6%；p=0.0028）。低色素性贫血在HIV感染的ISU（50.0%）、非ISU（61.9%）以及HIV阴性ISU（63.3%）中更为普遍，相较于HIV阴性非ISU（39.7%）与非物质使用对照组（56.3%；p=0.0007）。轻度免疫缺陷在HIV感染者中占比更高：HIV感染的ISU为32.3%、非ISU为21.2%，而HIV未感染的ISU为16.9%、非ISU为12.9%，非物质使用人群为14.3%；而重度免疫抑制则在HIV感染的物质使用人群中更为常见：ISU为14.5%、非ISU为15.2%，相较之下HIV未感染的物质使用人群中该比例仅为ISU 5.2%、非ISU 3.8%，由此可见HIV感染会加重物质使用人群的免疫抑制状况。

此外，药物诱导的免疫抑制与HIV未感染物质使用人群的贫血风险升高相关：ISU的比值比（OR）=3.95，95%置信区间（CI）=1.934~8.077，p<0.0001；非ISU的OR=3.63，CI=1.571~8.39，p=0.003。综上，低色素性贫血、正色素性贫血以及CD4+辅助T细胞减少症，是HIV感染与未感染的注射及非注射物质使用人群中最常见的血细胞减少症。