title: Anaemia in patients with HIV-associated TB: relative contributions of anaemia of chronic disease and iron deficiency.
abstract: BACKGROUND
  Anaemia commonly complicates both human immunodeficiency virus (HIV) infection and tuberculosis (TB), contributing substantially to morbidity and mortality. The mechanisms underlying anaemia and corresponding treatments in co-infected patients are poorly defined.
  
  
  OBJECTIVE
  To determine the relative contributions of anaemia of chronic disease (ACD) and iron deficiency to anaemia in patients with HIV-associated TB.
  
  
  METHODS
  Consecutively recruited hospitalised (n = 102) and matched ambulatory patients (n = 51) with microbiologically confirmed HIV-associated TB in Cape Town, South Africa, were included. Haemoglobin levels, iron status markers, hepcidin and pro-inflammatory cytokines in blood were measured. We determined the prevalence of ACD and iron-deficiency anaemia (IDA) using seven different published definitions of IDA.
  
  
  RESULTS
  More than 80% of enrolled HIV-associated TB patients were anaemic, and anaemia was more severe among in-patients. Over 95% of anaemic HIV-associated TB patients had ACD, whereas the proportion with IDA using a range of seven different definitions was low overall (median <3%, range 0-32.6) in both patient groups. The proportion with IDA and hepcidin concentration ⩿ 20.0 ng/ml (predictive of responsiveness to oral iron supplementation) was also very low (median <3%, range 0-15.1).
  
  
  CONCLUSIONS
  ACD was the predominant cause underlying anaemia in HIV-associated TB patients, and IDA was very uncommon in this setting. The majority of anaemic HIV-associated TB patients were unlikely to benefit from oral iron supplementation.
authors.affiliation: Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA; Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands; The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: A D
authors.initials: AD
authors.lastname: Kerkhoff
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Division of Haematology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; C17 Clinical Pathology Laboratory, National Health Laboratory Service and Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Opie
authors.affiliation: The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Vogt
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Jhilmeet
authors.affiliation: The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.affiliation: The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Lawn
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006397:Hematinics / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D006397:Hematinics