Relationship between blood concentrations of hepcidin and anaemia severity, mycobacterial burden and mortality in patients with HIV-associated tuberculosis.


Kerkhoff, AD; Meintjes, G; Burton, R; Vogt, M; Wood, R; Lawn, SD; (2015) Relationship between blood concentrations of hepcidin and anaemia severity, mycobacterial burden and mortality in patients with HIV-associated tuberculosis. The Journal of infectious diseases, 213 (1). pp. 61-70. ISSN 0022-1899 DOI: https://doi.org/10.1093/infdis/jiv364

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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.<br/> 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, &quot;hospitalized patients&quot;), 58 ambulatory outpatients with HIV infection and newly diagnosed tuberculosis (hereafter, &quot;ambulatory patients with tuberculosis&quot;), and 58 ambulatory outpatients with HIV infection and without tuberculosis (hereafter, &quot;ambulatory patients without tuberculosis&quot;). Blood hepcidin concentrations were determined for all patients. Vital status at 3 months was determined, and independent predictors of mortality were identified.<br/> 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 &lt; .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.<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 26136467
Web of Science ID: 371152700010
URI: http://researchonline.lshtm.ac.uk/id/eprint/2228463

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