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Reference: McDermid, JM, Hennig, BJ, van der Sande, M et al., (2013). Host iron redistribution as a risk factor for incident tuberculosis in HIV infection: an 11-year retrospective cohort study. BMC Infectious Diseases, 13 (1), Article: 48.Citable link to this page:

 

Host iron redistribution as a risk factor for incident tuberculosis in HIV infection: an 11-year retrospective cohort study.

Abstract: BACKGROUND: Identifying people at higher risk of developing tuberculosis with human immunodeficiency virus (HIV) infection may improve clinical management of co-infections. Iron influences tuberculosis (TB) pathogenesis, but understanding the exact mechanisms of how and timing of when iron is involved remains challenging since biological samples are rarely available from the disease susceptibility period due to the difficulty in predicting in who and when, if ever, TB will develop. The objective of this research was to determine how host iron status measured at HIV diagnosis and genotypes related to host iron metabolism were associated with incident TB. METHODS: Archived clinical data, plasma and DNA were analyzed from 1139 adult participants in a large HIV-1, HIV-2 and dual seroprevalent cohort based at the Medical Research Council Laboratories in The Gambia. Incident pulmonary and/or extrapulmonary TB diagnoses a minimum of 28 days after HIV diagnosis were independently re-confirmed using available evidence (n=152). Multiple host iron status biomarkers, Haptoglobin and solute carrier family 11, member 1 (SLC11A1) genotypes were modeled to characterize how indicators of host iron metabolism were associated with TB susceptibility. RESULTS: Hemoglobin (incidence rate ratio, IRR=0.88, 95% CI=0.79-0.98), plasma transferrin (IRR=0.53, 0.33-0.84) and ferritin (IRR=1.26, 1.05-1.51) were significantly associated with TB after adjusting for TB susceptibility factors. While genotype associations were not statistically significant, SLC11A1 associations replicated similar directions as reported in HIV-seronegative meta-analyses. CONCLUSIONS: Evidence of host iron redistribution at HIV diagnosis was associated with incident TB, and genetic influences on iron homeostasis may be involved. Low hemoglobin was associated with subsequent diagnosis of TB, but when considered in combination with additional iron status biomarkers, the collective findings point to a mechanism whereby anemia and iron redistribution are likely due to viral and/or bacteria-driven processes and the host immune response to infection. As a result, iron supplementation may not be efficacious or safe under these circumstances. Clinical and nutritional management of HIV and Mycobacterium tuberculosis co-infected individuals, especially in regions where food insecurity and malnutrition co-exist, may be further improved when the iron-related TB risk factors identified here are better understood and managed to favor host rather than pathogen outcomes.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's versionNotes:© 2013 McDermid et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bibliographic Details

Publisher: BioMed Central Ltd.

Publisher Website: http://www.biomedcentral.com/

Journal: BMC Infectious Diseasessee more from them

Publication Website: http://www.biomedcentral.com/bmcinfectdis/

Issue Date: 2013

pages:Article: 48Identifiers

Urn: uuid:e35969f0-12ff-4b2d-a424-92d2aec246ba

Source identifier: 388189

Eissn: 1471-2334

Doi: https://doi.org/10.1186/1471-2334-13-48

Issn: 1471-2334 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Humans Tuberculosis HIV Infections Iron Biological Markers Retrospective Studies CD4 Lymphocyte Count Genotype Adult Alleles Middle Aged Young Adult Genetic Predisposition to Disease Coinfection Risk Factors Female Male Tiny URL: pubs:388189

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Autor: McDermid, JM - - - Hennig, BJ - - - van der Sande, M - - - Hill, AV - institutionUniversity of Oxford Oxford, MSD, Clinical Medic

Fuente: https://ora.ox.ac.uk/objects/uuid:e35969f0-12ff-4b2d-a424-92d2aec246ba



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