title: Increase of haemoglobin levels by anti-retroviral therapy is associated with a decrease in immune activation.
abstract: METHODS
  We evaluated whether an increase in haemoglobin levels in the first 6 months of effective anti-retroviral therapy (ART) is associated with a decrease in immune activation. To reduce confounding factors only men (n = 35) and patients not receiving agents known to enhance haematopoiesis or patients without diseases that might suppress haematopoiesis were included. Simultaneously parameters of iron metabolism and cofactors for haematopoiesis were analysed.
  
  
  RESULTS
  A median baseline haemoglobin level of 139 g L-1 increased to 149 g L-1 at month 6 of ART (P < 0.001). At baseline low haemoglobin levels were strongly associated with high neopterin concentrations (r = - 0.64, P < 0.001), and much less correlated to high HIV-1 RNA levels (r = - 0.41, P < 0.05) and to a lower CD4+ cell count (r = 0.33, P < 0.05). The change of neopterin levels during the study period correlated with the relative change in haemoglobin levels, r = - 0.35, P = 0.03, whereas no such correlations were found for the change of HIV-1 RNA levels and the CD4 cell count. A logistic regression analysis revealed that the change of neopterin and soluble transferrin receptors concentrations are independently associated with an increase of haemoglobin levels of more than 15 g L-1.
  
  
  CONCLUSIONS
  Our study supports a cause-effect relationship between immune activation and anaemia in HIV-infected patients. Treatment of patients with ART decreases virus load, which may thereby result in silencing of immune effector activity thus ameliorating anaemia by reversing the anti-proliferative effects of cytokines towards erythroid progenitors and the iron withdrawal strategy of the immune system.
authors.affiliation: HIV Unit, Department of Dermatology and Venereology, Leopold-Franzens University-Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
authors.forename: Mario
authors.initials: M
authors.lastname: Sarcletti
authors.forename: Gisela
authors.initials: G
authors.lastname: Quirchmair
authors.forename: Günter
authors.initials: G
authors.lastname: Weiss
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fuchs
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology*; D018791:CD4 Lymphocyte Count; D006678:HIV / Q000235:genetics; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000502:physiology*; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood; D012367:RNA, Viral / Q000097:blood; D011990:Receptors, Transferrin / Q000097:blood; D012044:Regression Analysis
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins; D012367:RNA, Viral; D011990:Receptors, Transferrin; D019798:Neopterin