Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV.

Autor:	Demitto FO; Programa de Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Araújo-Pereira M; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil., Schmaltz CA; Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Sant'Anna FM; Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Arriaga MB; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil., Andrade BB; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil.; Universidade Salvador (UNIFACS), Laureate International Universities, Salvador, Brazil.; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States., Rolla VC; Programa de Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.; Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Jazyk:	angličtina
Zdroj:	Frontiers in immunology [Front Immunol] 2020 Sep 24; Vol. 11, pp. 588405. Date of Electronic Publication: 2020 Sep 24 (Print Publication: 2020).
DOI:	10.3389/fimmu.2020.588405
Abstrakt:	Tuberculosis (TB) is associated with systemic inflammation and anemia, which are aggravated in persons living with HIV (PLWH). Here, we characterized the dynamics of hemoglobin levels in PLWH coinfected with TB undergoing antitubercular therapy (ATT). We also examined the relationships between anemia and systemic inflammatory disturbance as well as the association between persistent anemia and unfavorable clinical outcomes. Data on several blood biochemical parameters and on blood cell counts were retrospectively analyzed in a cohort of 256 TB/HIV patients from Brazil during 180 days of ATT. Multidimensional statistical analyses were employed to profile systemic inflammation of patients stratified by anemia status (hemoglobin levels <12 g/dL for female and <13.5 g/dL for male individuals) prior to treatment and to perform prediction of unfavorable outcomes, such as treatment failure, loss to follow up and death. We found that 101 (63.63%) of patients with anemia at pre-ATT persisted with such condition until day 180. Such individuals exhibited heightened degree of inflammatory perturbation (DIP), which in turn was inversely correlated with hemoglobin levels. Recovery from anemia was associated with increased pre-ATT albumin levels whereas persistent anemia was related to higher total protein levels in serum. Multivariable regression analysis revealed that lower baseline hemoglobin levels was the major determinant of the unfavorable outcomes. Our findings demonstrate that persistent anemia in PLWH during the course of ATT is closely related with chronic inflammatory perturbation. Early intervention to promote recovery from anemia may improve ATT outcomes. (Copyright © 2020 Demitto, Araújo-Pereira, Schmaltz, Sant’Anna, Arriaga, Andrade and Rolla.)
Databáze:	MEDLINE
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