Severe Anemia Is an Independent Risk Factor for In-Hospital Death in Persons Living with HIV in Southern China: A Retrospective Cohort Study

To assess the impact of anemia severity during antiretroviral therapy (ART) on in-hospital mortality among persons living with HIV. We conducted a retrospective cohort study of hospitalized persons living with HIV at the Fourth People's Hospital of Nanning, Guangxi, China, from 2018 to 2020. Kaplan-Meier analysis was used to calculate cumulative mortality rates. The Cox proportional hazards model, 1:1:1 propensity score matching (PSM), and three-group inverse probability of treatment weighting (IPTW) were used to assess the impact of anemia severity on mortality in hospitalized persons living with HIV. A total of 2,217 hospitalized persons living with HIV were included, among whom 409 (18.4%) had anemia: 50 (2.3%) with mild anemia, 174 (7.8%) with moderate anemia, and 185 (8.3%) with severe anemia. Among all AIDS-related complications, patients with severe anemia had a higher mortality rate [20.34/100 person-months, 95% confidence interval (CI): 13.29-27.39], significantly higher than that of persons living with HIV without anemia (7.74/100 person-months, 95% CI: 6.02-9.45); the adjusted hazard ratio (AHR) was 2.422, with a 95% CI of (1.500, 3.913). After PSM and IPTW analyses, results were similar, with PSM (AHR: 4.745, 95% CI: 2.231-10.091) and IPTW (AHR: 1.920, 95% CI: 1.146-3.216). Patients with CD4⁺ T cell counts below 350 per μL and severe anemia had an increased mortality risk. Severe anemia is an independent risk factor for in-hospital death in persons living with HIV in southern China. The importance of timely identification and assessment of anemia severity during ART and prompt treatment to correct anemia, which is crucial for improving anemia burden and prognosis for persons living with HIV.