Prevalence and risk factors of anemia among people living with HIV/AIDS in Southeast Asia: a systematic review and meta-analysis
Vaibhavkumar Shrivastav, M Yogesh, Arya Ramachandran, Naresh Makwana, Dipesh Parmar
Abstract
Anemia represents a critical hematological complication among people living with HIV/AIDS (PLHIV), significantly impacting morbidity and mortality. This systematic review and meta-analysis aimed to comprehensively evaluate anemia prevalence and identify key risk factors among PLHIV in Southeast Asia. We systematically searched PubMed, Scopus, Embase, and Web of Science (2000–2024) following PRISMA guidelines (PROSPERO: CRD42024610328). Random-effects meta-analysis was performed, with heterogeneity examined through meta-regression and subgroup analyses. Quality assessment utilized JBI critical appraisal tools. Analysis of 39 studies (n = 21,427) revealed a striking pooled anemia prevalence of 50% (95% CI: 43–57%, I2 = 99.6%). Compelling disparities emerged across subgroups: ART-naïve individuals showed markedly higher prevalence (58%) versus those on ART (38%), children demonstrated elevated rates (52%) compared to adults (49%) and pregnant women (37%), and lower-middle-income countries exhibited greater burden (50%) versus upper-middle-income countries (39%). Meta-regression identified critical risk factors: CD4 count < 200 cells/mm3 (OR = 3.56, 95% CI: 2.59–4.90), underweight BMI (OR = 4.75, 95% CI: 3.57–6.33), female gender (OR = 3.06, 95% CI: 2.71–3.45), and notably, zidovudine use (OR = 9.28, 95% CI: 1.18–73.0). Our findings reveal that anemia affects half of PLHIV in Southeast Asia, with vulnerable subgroups bearing a disproportionate burden. This evidence underscores the urgent need for enhanced screening protocols and targeted interventions, particularly among high-risk populations. Future research should prioritize intervention strategies for these vulnerable subgroups.