Characterizing pancytopenia in a large Asian cohort of people living with HIV: A 23-year nested case-control study

Pancytopenia, a severe hematologic comorbidity, raises significant clinical concern for increased morbidity and mortality in people living with HIV (PLWH). However, reports on its incidence, risk factors, real-world etiologies, longitudinal characteristics, or management strategies in PLWH are absent. Through a long-term study of a large Asian cohort, this work aims to provide insights into these aspects.

We conducted a nested case-control study involving 1586 PLWH visiting our institution from January 2000 to March 2023. Cases experienced at least one pancytopenia episode, while controls with no such history were matched by age, sex, and HIV transmission route. Demographic, clinical, and laboratory data were analyzed to identify risk factors, etiologies, clinical features, and outcomes regarding pancytopenia.

Pancytopenia occurred for 1-3 times in 82 patients (5.17 %), with an annual incidence of 2.82 % and a prevalence of 3.71 %. Advanced disease (WHO Stage 3-4) was an independent risk factor (aOR 2.88, 95 % CI 1.07-7.78, P = 0.03). The leading etiologies of pancytopenia included advanced HIV infection (36.3 %) and medication toxicity (36.3 %); co-infection and malignancy contributed to fewer cases. The majority of pancytopenia episodes occurred once per patient, typically within the early years of HIV diagnosis, did not require hospitalization, and could be resolved with a median of 21 weeks. Resolution of pancytopenia was accompanied by viral control and immune recovery. However, life-threatening anemia (Hgb<65 g/L) was a significant predictor for irreversibility (P = 0.035). A history of pancytopenia significantly impaired patient survival (P = 0.008).

Caution is warranted for the occurrence of pancytopenia in PLWH, particularly those with advanced disease. Effective antiretroviral therapy and medication review should be prioritized in managing pancytopenia, along with individualized screening for underlying opportunistic conditions. Attention is needed for patients with a history of pancytopenia due to poorer prognosis.