High levels of serum IL-6 and serum hepcidin and low CD4 cell count were risk factors of anemia of chronic disease in HIV patients on the combination of antiretroviral therapy

Abstract

I Ketut Agus Somia,1 Tuti Parwati Merati,1 I Made Bakta,2 Ida Bagus Putra Manuaba,3 Wayan Putu Sutirta Yasa,4 I Dewa Made Sukrama,5 Ketut Suryana,6 Rudi Wisaksana71Division of Tropical and Infectious Disease, Department of Internal Medicine, Udayana University-Sanglah Hospital, Denpasar, Bali, Indonesia; 2Division of Hematology and Medical Oncology, Department of Internal Medicine, Udayana University–Sanglah Hospital, Denpasar, Bali, Indonesia; 3Chemistry Department, Faculty of Math and Science, Udayana University, Denpasar, Bali, Indonesia; 4Department of Clinical Pathology, Udayana University–Sanglah Hospital, Denpasar, Bali, Indonesia; 5Department of Clinical Microbiology, Udayana University-Sanglah Hospital, Denpasar, Bali, Indonesia; 6Division of Allergy and Immunology, Department of Internal Medicine, Udayana University-Wangaya Hospital, Denpasar, Bali, Indonesia; 7Division of Tropical and Infectious Disease, Department of Internal Medicine, Padjajaran University, Bandung, West Java, IndonesiaPurpose: This study aimed to determine whether high levels of serum IL-6 and serum hepcidin and CD4<350 cells/ul were risk factors for the anemia of chronic disease (ACD) in HIV-infected patients on the combination of antiretroviral (cARV) therapy with successful clinically and immunological responses.Patients and Methods: A matched case–control study was conducted in the VCT clinic of Sanglah General Hospital, Indonesia, between January 1 and September 1, 2016. The case group was HIV patients with ACD, while the control group was HIV patients without ACD. Purposive consecutive sampling was employed in HIV patients aged 15–65 years who have received cARV therapy for >6 months, had >95% adherence of cARV within 6 months, did not have any clinical failure, did not have any immunological failure and did not receive switch therapy within 6 months. Chi-square test and logistic regression analysis were performed.Results: A total of 42 cases and 42 controls were included in this study. Significant differences were found between case and control, which included serum IL-6, serum hepcidin, smoking, creatinine clearance, anemia at the initiation of cARV, CD4 at the initiation of cARV and actual CD4 (cell/μL). High levels of serum IL-6, high levels of serum hepcidin and CD4< 350 cells/μl were risk factors for ACD. After adjusted with anemia at cARV initiation and BMI, we found that high levels of serum IL-6 (adjusted OR: 17.682; 95% CI: 3.442–90.826), high levels of serum hepcidin (adjusted OR: 10.562; 95% CI: 2.531–44.076) and CD4 <350 cells/μl (adjusted OR: 4.181; 95% CI: 5.6–12.381) remain as risk factors for ACD.Conclusion: High levels of serum IL-6, high levels of serum hepcidin and CD4 count <350 cells/μL were risk factors for ACD in HIV patients with cARV therapy.Keywords: HIV infections, anemia, IL-6, hepcidins, CD4 cell count  

Keywords

• HIV infections
• Anemia
• Interleukin-6
• Hepcidins
• CD4 lymphocyte count