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Open Access Research article

Anemia and iron homeostasis in a cohort of HIV-infected patients in Indonesia

Rudi Wisaksana12*, Rachmat Sumantri1, Agnes R Indrati23, Aleta Zwitser4, Hadi Jusuf1, Quirijn de Mast4, Reinout van Crevel24 and Andre van der Ven4

Author Affiliations

1 Department of Internal Medicine Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, Bandung, Indonesia

2 Health Research Unit, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

3 Clinical Pathology Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, Bandung, Indonesia

4 Department of Internal Medicine, Radboud University Nijmegen Medical Centre, the Netherlands

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BMC Infectious Diseases 2011, 11:213  doi:10.1186/1471-2334-11-213

Published: 9 August 2011

Abstract

Background

Anemia is a common clinical finding in HIV-infected patients and iron deficiency or redistribution may contribute to the development of low hemoglobin levels. Iron overload is associated with a poor prognosis in HIV and Hepatitis C virus infections. Iron redistribution may be caused by inflammation but possibly also by hepatitis C co-infection. We examined the prevalence of anemia and its relation to mortality in a cohort of HIV patients in a setting where injecting drug use (IDU) is a main mode of HIV transmission, and measured serum ferritin and sTfR, in relation to anemia, inflammation, stage of HIV disease, ART and HCV infection.

Methods

Patient characteristics, ART history and iron parameters were recorded from adult HIV patients presenting between September 2007 and August 2009 in the referral hospital for West Java, Indonesia. Kaplan-Meier estimates and Cox's regression were used to assess factors affecting survival. Logistic regression was used to identity parameters associated with high ferritin concentrations.

Results

Anemia was found in 49.6% of 611 ART-naïve patients, with mild (Hb 10.5 - 12.99 g/dL for men; and 10.5 - 11.99 g/dL for women) anemia in 62.0%, and moderate to severe anemia (Hb < 10.5 g/dL) in 38.0%. Anemia remained an independent factor associated with death, also after adjustment for CD4 count and ART (p = 0.008). Seroprevalence of HCV did not differ in patients with (56.9%) or without anemia (59.6%). Serum ferritin concentrations were elevated, especially in patients with anemia (p = 0.07) and/or low CD4 counts (p < 0.001), and were not related to hsCRP or HCV infection. Soluble TfR concentrations were low and not related to Hb, CD4, hsCRP or ART.

Conclusion

HIV-associated anemia is common among HIV-infected patients in Indonesia and strongly related to mortality. High ferritin with low sTfR levels suggest that iron redistribution and low erythropoietic activity, rather than iron deficiency, contribute to anemia. Serum ferritin and sTfR should be used cautiously to assess iron status in patients with advanced HIV infection.

Keywords:
anemia; iron; HIV