Abstract
BACKGROUND & OBJECTIVES: 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. METHODS: 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. RESULTS: Analysis of 39 studies (n = 21,427) revealed a striking pooled anemia prevalence of 50% (95% CI: 43-57%, I(2) = 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/mm(3) (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). CONCLUSIONS: 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.