title: HIV and schistosomiasis in rural Zimbabwe: the association of retinol-binding protein with disease progression, inflammation and mortality.
abstract: BACKGROUND
  Vitamin A has widespread effects on immune function and is therefore interesting in HIV-infection. Retinol-binding protein (RBP or RBP4) is a negative acute-phase protein and a marker of vitamin A status. Our aim was to investigate the association of RBP with HIV progression, infection with schistosomiasis, inflammatory cytokines, and mortality.
  
  
  METHODS
  The study included 192 HIV-infected and 177 HIV-uninfected individuals from Mupfure in rural Zimbabwe. Of these, 208 were infected with Schistosoma haematobium, 27 with S. mansoni and 48 with both. Plasma RBP, HIV-RNA, CD4 cell count, haemoglobin, cytokines, clinical staging (CDC category), self-reported level of function (Karnoffsky Performance Score, KPS) and schistosomiasis status were assessed at baseline. Participants were followed up for survival 3-4 years post-enrolment.
  
  
  RESULTS
  RBP levels were lower in HIV-infected individuals(p<0.0001). Among HIV-infected individuals, multivariable analysis showed RBP to be positively correlated with CD4 cell count(p=0.050), KPS(p=0.003), and haemoglobin(p<0.0001) and negatively correlated with HIV-RNA(p<0.0001), CDC category(p<0.0001), tumor necrosis factor-receptor II(p<0.0001) and interleukin(IL)-6(p=0.004), as well as with IL-8(p=0.005) and IL-10(p=0.003) for HIV-infected men. Furthermore, among HIV-infected individuals RBP correlated negatively with schistosomiasis(p=0.038) and intensity of infection: circulating anodic antigen(p=0.014), circulating cathodic antigen(p<0.0001) and faecal egg output(p=0.004).
  
  
  CONCLUSIONS
  In HIV-infected individuals, RBP was negatively associated with levels of inflammatory markers, markers of HIV progression, infection with schistosomiasis and markers of schistosomal intensity.
authors.affiliation: Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: Sebastian.ranzi.kotze@clin.au.dk.
authors.forename: Sebastian Ranzi
authors.initials: SR
authors.lastname: Kotzé
authors.affiliation: Medical Research Council of Zimbabwe; Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rutendo
authors.initials: R
authors.lastname: Zinyama-Gutsire
authors.affiliation: Center for Global Health, Department of Public Health, Aarhus University.
authors.forename: Per
authors.initials: P
authors.lastname: Kallestrup
authors.affiliation: Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Christine Stabell
authors.initials: CS
authors.lastname: Benn
authors.affiliation: Department of Medical Laboratory Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Exnevia
authors.initials: E
authors.lastname: Gomo
authors.affiliation: Faculty of Health Sciences, and Cluster of International Health, University of Copenhagen, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.affiliation: Department of Parasitology, Leiden University Medical Centre, the Netherlands.
authors.forename: Govert
authors.initials: G
authors.lastname: van Dam
authors.affiliation: Cellular and Metabolic Research Section, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Ole Hartvig
authors.initials: OH
authors.lastname: Mortensen
authors.affiliation: Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Ullum
authors.affiliation: Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Erikstrup
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D060085:Coinfection / Q000175:diagnosis / Q000401:mortality; D016207:Cytokines / Q000097:blood; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D054839:Retinol-Binding Proteins, Plasma / Q000032:analysis*; D012424:Rural Population; D012552:Schistosomiasis / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D016207:Cytokines; C101326:RBP4 protein, human; D054839:Retinol-Binding Proteins, Plasma
keywords: Africa; HIV; Retinol-binding protein; mortality; schistosomiasis; vitamin A