TY - JOUR
T1 - Association between severe anaemia and inflammation, risk of IRIS and death in persons with HIV
T2 - A multinational cohort study
AU - Araújo-Pereira, Mariana
AU - Sheikh, Virginia
AU - Sereti, Irini
AU - Barreto-Duarte, Beatriz
AU - Arriaga, María B
AU - Tibúrcio, Rafael
AU - Vinhaes, Caian L
AU - Pinto-de-Almeida, Manuella
AU - Wang, Jing
AU - Rupert, Adam
AU - Roby, Gregg
AU - Shaffer, Douglas
AU - Phanuphak, Nittaya
AU - Sawe, Fred
AU - Andrade, Bruno B
N1 - Funding Information: Intramural Research Program of National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH). Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance code: 001) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.The authors thank the study participants and the staff in each clinical site. The study was supported in part by the Intramural Research Program of National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH). B.B-D. and M.A-P. received a fellowship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance code: 001). B.B.A. is senior investigator of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. Funding Information: The authors thank the study participants and the staff in each clinical site. The study was supported in part by the Intramural Research Program of National Institute of Allergy and Infectious Diseases / National Institutes of Health (NIAID/NIH). B.B-D. and M.A-P. received a fellowship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance code: 001). B.B.A., is senior investigator of the Conselho Nacional de Desenvolvimento Científico e Tecnológico ( CNPq ), Brazil. Publisher Copyright: © 2022 The Author(s)
PY - 2022/11
Y1 - 2022/11
N2 - BACKGROUND: After initiating antiretroviral therapy (ART), approximately 25% of people with HIV (PWH) may develop Immune Reconstitution Inflammatory Syndrome (IRIS), which is associated with increased morbidity and mortality. Several reports have demonstrated that low haemoglobin (Hb) levels are a risk factor for IRIS. To what extent the severity of anaemia contributes to the risk of IRIS and/or death is still insufficiently explored.METHODS: We investigated both the presence and severity of anaemia in PWH in a multinational cohort of ART-naïve patients. A large panel of plasma biomarkers was measured pre-ART and patients were followed up for 6 months. IRIS or deaths during this period were considered as outcomes. We performed multidimensional analyses, logistic regression, and survival curves to delineate associations.FINDINGS: Patients with severe anaemia (SA) presented a distinct systemic inflammatory profile, characterized by higher TNF, IL-6, and IL-27 levels. SA was independently associated with IRIS, with a higher risk of both early IRIS onset and death. Among IRIS patients, those with SA had a higher risk of mycobacterial IRIS.INTERPRETATION: PWH with SA display a more pronounced inflammatory profile, with an elevated risk of developing IRIS earlier and a statistically significant higher risk of death.FUNDING: Intramural Research Program of National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH). Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance code: 001) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.
AB - BACKGROUND: After initiating antiretroviral therapy (ART), approximately 25% of people with HIV (PWH) may develop Immune Reconstitution Inflammatory Syndrome (IRIS), which is associated with increased morbidity and mortality. Several reports have demonstrated that low haemoglobin (Hb) levels are a risk factor for IRIS. To what extent the severity of anaemia contributes to the risk of IRIS and/or death is still insufficiently explored.METHODS: We investigated both the presence and severity of anaemia in PWH in a multinational cohort of ART-naïve patients. A large panel of plasma biomarkers was measured pre-ART and patients were followed up for 6 months. IRIS or deaths during this period were considered as outcomes. We performed multidimensional analyses, logistic regression, and survival curves to delineate associations.FINDINGS: Patients with severe anaemia (SA) presented a distinct systemic inflammatory profile, characterized by higher TNF, IL-6, and IL-27 levels. SA was independently associated with IRIS, with a higher risk of both early IRIS onset and death. Among IRIS patients, those with SA had a higher risk of mycobacterial IRIS.INTERPRETATION: PWH with SA display a more pronounced inflammatory profile, with an elevated risk of developing IRIS earlier and a statistically significant higher risk of death.FUNDING: Intramural Research Program of National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIAID/NIH). Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance code: 001) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.
KW - Death
KW - HIV
KW - IRIS
KW - Systemic inflammation
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85140356879&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ebiom.2022.104309
DO - https://doi.org/10.1016/j.ebiom.2022.104309
M3 - Article
C2 - 36283285
SN - 2352-3964
VL - 85
SP - 104309
JO - eBioMedicine
JF - eBioMedicine
M1 - 104309
ER -