Abstract: Objective This retrospective study analyzed data from patients co-infected with HIV and Talaromyces marneffei(TM) at Nanning Fourth People's Hospital. Its objectives were to compare the epidemiological differences between anemic and non-anemic cohorts, identify determinants influencing anemia development. The findings aim to inform clinical risk stratification and enable precision interventions. Method The study population consisted of HIV-infected patients with Talaromyces marneffei co-infection who were hospitalized for the first time at Nanning Fourth People’s Hospital between 2012 and 2023. Subjects were identified according to predefined inclusion and exclusion criteria. Demographic, clinical, and laboratory data were extracted from the hospital’s electronic medical record system. Anemia status was assigned using the WHO diagnostic criteria, permitting categorization into anemic and non-anemic groups and further stratification by anemia severity. Statistical analyses were performed with SPSS 25.0. Inter-group differences in epidemiological characteristics and clinical manifestations were assessed by univariate methods including t test, X² test, and non-parametric tests as appropriate. Multivariable Logistic regression was used to identify independent determinants of anemia. Result A total of 2296 HIV/TM co-infected patients admitted to Nanning Fourth People’s Hospital between 2012 and 2023 were enrolled. The cohort comprised 1841 (80.2%) males and 455(19.8%) females, with a mean age of (45.19±14.41) years. Anemia was present in 1937 patients(84.4%), among these, 881(45.5%) had mild, 887(45.8%) moderate, and 169(8.7%) severe anemia. Compared with non-anemic subjects, anemic patients exhibited higher proportions of individuals aged ≥60 years, disease onset during summer, positive TM blood cultures, and thrombocytopenia (all P<0.05). Lymphocyte subset analyses revealed that CD3⁺, CD4⁺, and CD8⁺ T-cell counts were significantly lower in the anemia group (P<0.05).Across anemia severity strata, significant differences were observed in the frequencies of fatigue, anorexia, diarrhea, gastrointestinal bleeding, hepatosplenomegaly, lymphadenopathy, and skin rash (P<0.05).Multivariable Logistic regression identified the following independent risk factors for anemia: positive TM blood culture (OR=1.410, 95%CI: 1.030-1.930), age≥60 years (OR=1.702, 95%CI:1.222-2.371), and thrombocytopenia (OR=1.928, 95%CI: 1.484-2.503). Conversely, concomitant diabetes mellitus（OR=0.322, 95%CI: 0.179-0.579） and higher CD4⁺ T-cell counts（OR=0.637, 95%CI：0.442-0.917） were associated with a reduced risk. Conclusion Among HIV/Talaromyces marneffei co-infected patients, the incidence of anemia is markedly elevated. As anemia severity increases, manifestations such as hepatosplenomegaly, lymphadenopathy, and cutaneous eruptions become more prevalent, necessitating vigilant monitoring for early intervention. In clinical practice, particular attention should be directed to older patients, with close tracking of T. marneffei blood-culture results, platelet counts, and CD4⁺ T-cell levels to promptly recognize and mitigate the therapeutic and prognostic risks imposed by anemia.

Key words: Human Immunodeficiency Virus, Talaromyces marneffei, Anemia, Influencing Factors