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 Wang1,2, *, , Xiangqing Hou2,3, *, , Xianghua Yu1, , Tao Wang2,4, , Zhenmiao Ye1, , Jushuang Li2,4, , Feifei Su5, , Chengnan Guo2,4, , Fang Peng2,4, , Shuzhen Zhao2,4, , Huihui Li2,4, , Jingjing Zuo6, , Dehua Su1, , Lina Zhao1, , Hemei Zhang1, , Xiangyang Chen1, , Ruoqiu Wang1, , Qipeng Xie7, , Chao Zheng8, , Guangyun Mao2,4,6, ,

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

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

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.


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.


BMI: body mass index; PLT: platelet; ALB: albumin; AP: alkaline phosphatase; Tbil: total bilirubin; TB: tuberculosis; WBC: white blood cell; VL: viral load; HB: hemoglobin; Cr: creatinine; TG: triglyceride; FPG: fasting plasma glucose; TC: total cholesterol; ALT: alanine transaminase; AST: aspartate transaminase; C-index: concordance index; NRI: net reclassification index; IDI: integrated discrimination index; CI: confidence interval.