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J Infect Dis. 2016 Jan 1;213(1):61-70. doi: 10.1093/infdis/jiv364. Epub 2015 Jul 1.

Relationship Between Blood Concentrations of Hepcidin and Anemia Severity, Mycobacterial Burden, and Mortality Among Patients With HIV-Associated Tuberculosis.

Author information

1
Department of Medicine, University of California San Francisco School of Medicine Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, The Netherlands The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine.
2
Department of Medicine, Faculty of Health Sciences Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Department of Medicine, Imperial College.
3
Department of Medicine, Khayelitsha District Hospital, Cape Town, South Africa.
4
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine.
5
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.

Abstract

BACKGROUND:

Anemia is very common in patients with human immunodeficiency virus (HIV)-associated tuberculosis, and hepcidin may be key in mediating this. We explored the relationship between blood hepcidin concentrations and anemia severity, mycobacterial burden and mortality in patients with HIV-associated tuberculosis.

METHODS:

Consecutive unselected HIV-infected adults in South Africa were systematically investigated for tuberculosis. Three groups were studied: 116 hospitalized inpatients with HIV infection and tuberculosis (hereafter, "hospitalized patients"), 58 ambulatory outpatients with HIV infection and newly diagnosed tuberculosis (hereafter, "ambulatory patients with tuberculosis"), and 58 ambulatory outpatients with HIV infection and without tuberculosis (hereafter, "ambulatory patients without tuberculosis"). Blood hepcidin concentrations were determined for all patients. Vital status at 3 months was determined, and independent predictors of mortality were identified.

RESULTS:

Median hepcidin concentrations were 38.8 ng/mL among hospitalized patients, 19.1 ng/mL among ambulatory patients with tuberculosis, and 5.9 ng/mL among ambulatory patients without tuberculosis (P < .001). In both groups with HIV-associated tuberculosis, hepcidin concentrations were strongly associated with greater anemia severity. Additionally, strong, graded associations were observed between hepcidin and composite indices of mycobacterial burden and dissemination. Patients dying within 3 months had significantly higher hepcidin concentrations, which independently predicted mortality.

CONCLUSIONS:

High hepcidin concentrations were strongly associated with disseminated disease, anemia, and poor prognosis in patients with HIV-associated tuberculosis. Hepcidin may be a mechanistically important mediator underlying the high prevalence of severe anemia in these patients.

KEYWORDS:

AIDS; Africa; HIV; anemia; antimicrobial; hepcidin; tuberculosis

PMID:
26136467
PMCID:
PMC4676545
DOI:
10.1093/infdis/jiv364
[Indexed for MEDLINE]
Free PMC Article

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