Cytokine activation is predictive of mortality in Zambian patients with AIDS-related diarrhoea

doi:10.1186/1471-2334-8-156

BMC Infectious Diseases
Volume 8

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Hassan G
Njobvu RN L
Dhaliwal W
Sianongo S
Kelly P

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Hassan G
Njobvu RN L
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Sianongo S
Kelly P
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Research article

Cytokine activation is predictive of mortality in Zambian patients with AIDS-related diarrhoea

Isaac Zulu¹^,2 , Ghaniah Hassan² , Lungowe Njobvu RN¹ , Winnie Dhaliwal² , Sandie Sianongo¹ and Paul Kelly¹^,2^,3

¹Tropical Gastroenterology and Nutrition group, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia

²Institute of Cell and Molecular Science, Barts & The London, School of Medicine, London, UK

³London School of Hygiene & Tropical Medicine, London, UK

author email corresponding author email

BMC Infectious Diseases 2008, 8:156doi:10.1186/1471-2334-8-156


Published:	13 November 2008

Abstract

Background

Mortality in Zambian AIDS patients is high, especially in patients with diarrhoea, and there is still unacceptably high mortality in Zambian patients just starting anti-retroviral therapy. We set out to determine if high concentrations of serum cytokines correlate with mortality.

Methods

Serum samples from 30 healthy controls (HIV seropositive and seronegative) and 50 patients with diarrhoea (20 of whom died within 6 weeks) were analysed. Concentrations of tumour necrosis factor receptor p55 (TNFR p55), macrophage migration inhibitory factor (MIF), interleukin (IL)-6, IL-12, interferon (IFN)-γ and C-reactive protein (CRP) were measured by ELISA, and correlated with mortality after 6 weeks follow-up.

Results

Apart from IL-12, concentrations of all cytokines, TNFR p55 and CRP increased with worsening severity of disease, showing highly statistically significant trends. In a multivariable analysis high TNFR p55, IFN-γ, CRP and low CD4 count (CD4 count <100) were predictive of mortality. Although nutritional status (assessed by body mass index, BMI) was predictive in univariate analysis, it was not an independent predictor in multivariate analysis.

Conclusion

High serum concentrations of TNFR p55, IFN-γ, CRP and low CD4 count correlated with disease severity and short-term mortality in HIV-infected Zambian adults with diarrhoea. These factors were better predictors of survival than BMI. Understanding the cause of TNFR p55, IFN-γ and CRP elevation may be useful in development of interventions to reduce mortality in AIDS patients with chronic diarrhoea in Africa.