The Association of Anemia on Non-AIDS-Defining Cancer and Subsequent Survival Among People With HIV After Antiretroviral Initiation
Bibliographic record
Abstract
BACKGROUND: The association of anemia as a predictive and prognostic indicator of non-AIDS-defining cancer (NADC) among people with HIV (PWH) remains unknown. We evaluated the presence of anemia and its severity as a predictor of NADC and 5-year all-cause survival after an NADC diagnosis among PWH who had initiated antiretroviral therapy. SETTING: North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). METHODS: We included PWH (≥18 years) on ART between January 01, 2007, and December 31, 2016, with no prior cancer diagnosis. Annual median hemoglobin was categorized into mild (11.0-12.9 g/dL men, 11.0-11.9 g/dL women) and moderate/severe (<10.9 g/dL regardless of sex) anemia. Discrete time-to-event models using a complementary log-log link estimated crude and adjusted hazards ratios (aHR) and 95% confidence intervals for NADC by anemia severity. Five-year mortality after NADC diagnosis by anemia was evaluated. RESULTS: Among 67,228 PWH contributing 301,421 annual median hemoglobin observations, 244,658 (81%) were not anemic, 40,134 (13%) had mild, and 16,629 (6%) had moderate/severe anemia. The risk of NADC was higher among PWH with anemia (aHR 2.40 [2.19 to 2.63]) (vs. no anemia) and greater among men (aHR 2.42 [2.20 to 2.66]) than women (aHR 2.02 [1.42 to 2.89]). NADC risk increased with worsening anemia (mild: aHR 2.01 [1.81 to 2.23], moderate/severe: aHR 3.59 [3.13 to 4.11]). The 5-year all-cause mortality after NADC diagnosis was higher (aHR 1.37 [1.21 to 1.55]) among PWH with anemia. CONCLUSIONS: Among PWH who initiated ART, anemia may serve as a predictive indicator of NADC risk. Identification of anemia should warrant investigations into the underlying etiology, including evaluation for NADC. Anemia is also a prognostic indicator among PWH diagnosed with NADC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".