Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi.
BACKGROUND
Although anemia is common among adults with pulmonary tuberculosis and human immunodeficiency virus (HIV) infection in sub-Saharan Africa, the factors contributing to its pathogenesis have not been well characterized.


OBJECTIVE
To characterize the antioxidant micronutrient status, interleukin-6 (IL-6) concentrations, and HIV load in relationship with anemia in adults with pulmonary tuberculosis.


METHODS
Zomba district, Malawi.


METHODS
Erythropoietin, IL-6, plasma HIV load, and markers of micronutrient status (hemoglobin (Hb), plasma concentrations of retinol, alpha-tocopherol, carotenoids, ferritin, zinc, and selenium) were measured in 500 adults who presented with pulmonary tuberculosis in Zomba Central Hospital, Malawi.


RESULTS
Among 370 HIV-positive and 130 HIV-negative adults, the prevalence of anemia was 88 and 77%, respectively (P = 0.002), and moderate to severe anemia (Hb < 80 g/l) occurred in 30 and 15%, respectively (P = 0.001). Geometric mean IL-6 concentration was 21.1 pg/ml, with no difference between HIV-positive and -negative adults. The erythropoietin response to anemia was not different between adults with elevated IL-6 and those with lower IL-6 concentrations. In a multivariate logistic regression model, HIV load, and lower plasma selenium concentrations were associated with moderate to severe anemia. In a final multivariate linear regression model, IL-6, plasma HIV load, and plasma selenium concentrations were associated with Hb concentrations.


CONCLUSIONS
This study suggests that low selenium concentrations, high HIV load, and high IL-6 concentrations are associated with anemia in adults with pulmonary tuberculosis in sub-Saharan Africa.
van Lettow
M
M
Johns Hopkins University School of Medicine, Baltimore, USA. mvlettow@imailbox.com
West
C E
CE
van der Meer
J W M
JW
Wieringa
F T
FT
Semba
R D
RD
D000328:Adult; D000740:Anemia / Q000097:blood / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D018977:Micronutrients / Q000097:blood; D015995:Prevalence; D012307:Risk Factors; D012643:Selenium / Q000097:blood*; D012720:Severity of Illness Index; D014397:Tuberculosis, Pulmonary / Q000097:blood*
D015415:Biomarkers; D015850:Interleukin-6; D018977:Micronutrients; D012643:Selenium