Anemia and Immune-Hematologic profiles in Virally Suppressed People with HIV: Findings from a Cross-Sectional Study

BackgroundAnemia remains a prevalent complication among people living with HIV (PLWH), even among virally suppressed PLWH. Sustained Immune activation, erythropoietin deficiency and disturbances in iron metabolism are thought to contribute to persistent anemia, yet their roles remain poorly defined in this population. This study investigated immune-hematologic profiles associated with anemia in virally suppressed PLWH. MethodsA cross-sectional study was conducted among 155 virally suppressed PLWH attending the Livingstone University Teaching Hospital. Participants were classified as anaemic or non-anaemic based on WHO haemoglobin criteria. Demographic, clinical, and laboratory data including cytokines, inflammatory markers, and iron metabolism indices were collected. Descriptive statistics, bivariate analyses, and logistic regression models were used to evaluate associations with anemia. ResultsAnemia was present in 28.4% (95% CI: 21.4%-36.4%) of participants and was significantly more common in females than males (40.9% vs. 15.6%, p = 0.002). In the adjusted logistic regression models, increasing age was significantly associated with higher odds of anemia (AOR = 1.13; 95% CI: 1.021-1.252; p = 0.018). Among the cytokines analyzed, interferon-gamma (IFN-{gamma}) was the only marker significantly elevated in participants with anemia (AOR = 1.003; 95% CI: 1.001-1.005; p = 0.012), while interleukin-17a (IL-17a) demonstrated a borderline inverse association (AOR = 0.99; 95% CI: 0.99-1.00; p = 0.051). Among hematologic markers, a soluble transferrin receptor-to-ferritin (sTfR-Ferritin) index >2 was significantly associated with anemia (AOR = 6.54; 95% CI: 1.001-42.76; p = 0.048), alongside female sex (AOR = 10.01; 95% CI: 1.08-92.64; p = 0.042). ConclusionAnemia remains a prevalent comorbidity among virally suppressed PLWH, particularly in women. Independent associations with anemia include advancing age, elevated interferon-gamma levels, and an increased soluble transferrin receptor-to-ferritin index, reflecting immune activation and depleted iron stores. These findings underscore the need for integrated monitoring strategies beyond virologic control, incorporating immune and iron metabolism biomarkers to improve the early detection and management of anemia in this population.