Anaemia in patients with HIV-associated TB: relative contributions of anaemia of chronic disease and iron deficiency

作者：Kerkhoff A D; Meintjes G; Opie J; Vogt M; Jhilmeet N; Wood R; Lawn S D

来源：International Journal of Tuberculosis and Lung Disease, 2016, 20(2): 193-201.

DOI：10.5588/ijtld.15.0558

• human immunodeficiency virus
• AIDS
• tuberculosis
• Africa
• anaemia
• mechanism
• iron
• hepcidin

BACKGROUND: Anaemia commonly complicates both human immunodeficiency virus (HIV) infection and tuberculosis (TB), contributing substantially to morbidity and mortality. The mechanisms underlying anaemia and corresponding treatments in co-infected patients are poorly defined.
OBJECTIVE: To determine the relative contributions of anaemia of chronic disease (ACD) and iron deficiency to anaemia in patients with HIV-associated TB.
DESIGN: Consecutively recruited hospitalised (n = 102) and matched ambulatory patients (n = 51) with microbiologically confirmed HIV-associated TB in Cape Town, South Africa, were included. Haemoglobin levels, iron status markers, hepcidin and pro-inflammatory cytokines in blood were measured. We determined the prevalence of ACD and iron-deficiency anaemia (IDA) using seven different published definitions of IDA.
RESULTS: More than 80% of enrolled HIV-associated TB patients were anaemic, and anaemia was more severe among in-patients. Over 95% of anaemic HIV-associated TB patients had ACD, whereas the proportion with IDA using a range of seven different definitions was low overall (median < 3%, range 0-32.6) in both patient groups. The proportion with IDA and hepcidin concentration <= 20.0 ng/ml (predictive of responsiveness to oral iron supplementation) was also very low (median < 3%, range 0-15.1).
CONCLUSIONS: ACD was the predominant cause underlying anaemia in HIV-associated TB patients, and IDA was very uncommon in this setting. The majority of anaemic HIV-associated TB patients were unlikely to benefit from oral iron supplementation

• 出版日期2016-2