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与HIV感染的关联是公共卫生领域的重点研究方向，尤其聚焦于血液学与免疫学表型特征。对血液学及免疫状态的评估，对于优化疾病分类与临床管理（尤其是HIV阳性物质使用者）至关重要。然而，目前针对HIV感染的注射与非注射物质使用者所出现的血液学与免疫紊乱，相关研究数据仍较为匮乏。因此，本研究旨在明确HIV感染物质使用者的血液学与免疫紊乱实验室标志物。
本研究对肯尼亚滨海城市蒙巴萨的受试者静脉血标本开展血液学与免疫学特征分析，受试者分为：注射物质使用者（Injection Substance Users, ISU）——其中HIV感染者62例、HIV未感染者213例；非注射物质使用者——其中HIV感染者33例、HIV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ISU组（48.4%）与HIV感染非ISU组（63.6%）中均显著升高（p<0.0001）；HIV未感染ISU组（56.3%）的贫血患病率亦高于HIV未感染非ISU组（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ISU组（50.0%）、HIV感染非ISU组（61.9%）及HIV阴性ISU组（63.3%）中更为常见，相较于HIV阴性非ISU组（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ISU组为32.3%、HIV感染非ISU组为21.2%，而HIV未感染ISU组为16.9%、HIV未感染非ISU组为12.9%、非物质使用者对照组为14.3%；重度免疫抑制则多见于HIV感染物质使用者——ISU组14.5%、非ISU组15.2%，显著高于HIV未感染物质使用者的ISU组5.2%与非ISU组3.8%，由此可见HIV感染会加重物质使用者的免疫抑制状态。此外，在HIV未感染物质使用者中，药物诱导的免疫抑制与贫血发生风险升高显著相关：ISU组的比值比（Odds Ratio, OR）为3.95，95%置信区间（Confidence Interval, CI）为1.934~8.077（p<0.0001）；非ISU组OR为3.63，95%CI为1.571~8.39（p=0.003）。
综上，在HIV感染与未感染的注射及非注射物质使用者中，低色素性贫血、正色素性贫血与CD4+辅助T细胞减少症是最为常见的血细胞减少症。