Inadequate Erythropoietin Response to Anaemia in HIV Patients: Relationship to Serum Levels of Tumour Necrosis Factor‐Alpha, Interleukin‐6 and Their Soluble receptors

Kreuzer, Karl‐Anton; Rockstroh, Juergen; Jelkmann, Wolfgang; Theisen, Albert; Spengler, Ulrich; Sauerbruch, T.

doi:10.1046/j.1365-2141.1997.d01-2031.x

Cited by 52 publications

(34 citation statements)

References 16 publications

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“…Acredita-se que elas decorrem de fatores interrelacionados, como efeito direto do vírus HIV sobre as células progenitoras da medula óssea 9 e do timo 37 causando citopenias; alteração do microambiente da medula óssea 39,40 ; desregulação imune com produção de auto-anticorpos 33,38 ; medicação anti-retroviral, SMX-TMP, ganciclovir e aciclovir; agentes oportunistas, como Mycobacterium avium intracellulare e Citomegalovírus 7 ; desregulação das citocinas e o conseqüente descontrole da hematopoiese 7,10,41 . Parece não existir relação entre anticorpos antineutrófilos e antiplaquetas com as respectivas citopenias em crianças 9,42 e adultos 33,38 .…”

Section: Discussionunclassified

Evolution of hematological parameters in a group of children with human immunodeficiency virus infection - HIV 1

Silva¹,

Silva²,

Vilela³

1999

J Pediatr (Rio J)

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Objective: To analyze the evolution of clinical and hematological aspects of the children infected with HIV 1.Methods: Using the CDC criteria, 1994, 37 children with HIV infection were selected, followed up at the Immunodeficiency Clinic at UNICAMP. The study is longitudinal descriptive. Complete blood count, ferritin, serum iron, TIBC and direct Coombs were carried out.Results: The clinical category that predominated was B (45.94%) and categories A and C were equal (27.03%). All of them were having antiretroviral therapy. Hypochromic and microcytic anemia were seen in 100% of patients up to 12 months of age. There was association between anemia and the progression of the disease, both clinical (p=0.031) and immunological (p=0.0027) and with lymphopenia too (p=0.033). Thrombocytopenia occurred in 10 to 25% of the patients. Low serical ferritin was seen in 2.7% of the cases and low serum iron in 11.1%. All the 15 patients analyzed had negative Coombs test. There was weight and height reduction in 23.5 to 45% of the children and 70.3% had clinical manifestations up to 9 months of age. During the follow up 13.2% of the patients died.Conclusions: There was association between anemia and lymphopenia with the progression of the disease. In relation to the aetiology of the anemia, about 10% can be considered anemia of chronic disease. Probably the hematological abnormalities seen in peripheral blood are the consequences of loss of control of cellular death mechanism and hematopoiesis in individuals infected by HIV 1.J. pediatr. (Rio J.). 1999; 75(6): 442-448: acquired immunodeficiency syndrome, anemia, lymphopenia.

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Section: Discussionunclassified

Evolution of hematological parameters in a group of children with human immunodeficiency virus infection - HIV 1

Silva¹,

Silva²,

Vilela³

1999

J Pediatr (Rio J)

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“…Severity of anaemia correlates with serum concentration of soluble tumour necrosis factor receptor and interleukin 6 (Kreuzer et al, 1997). The anaemia of AIDS is associated with an inadequate erythropoietin response (Kreuzer et al, 1997) and erythropoietin appears to be of benefit in raising the haematocrit and reducing the transfusion requirements in those zidovudine-treated patients with a lower baseline erythropoietin concentration (Henry et al, 1992). Megaloblastic erythropoiesis may be observed in the absence of zidovudine therapy.…”

Section: General Haematological Features Of Aidsmentioning

confidence: 97%

“…Tumour necrosis factor, which is an important mediator of the anaemia of chronic disease, is elevated in the serum of patients with AIDS and the AIDS-related complex but not in the serum of those with asymptomatic infection (Lähdevirta et al, 1988). Severity of anaemia correlates with serum concentration of soluble tumour necrosis factor receptor and interleukin 6 (Kreuzer et al, 1997). The anaemia of AIDS is associated with an inadequate erythropoietin response (Kreuzer et al, 1997) and erythropoietin appears to be of benefit in raising the haematocrit and reducing the transfusion requirements in those zidovudine-treated patients with a lower baseline erythropoietin concentration (Henry et al, 1992).…”

Section: General Haematological Features Of Aidsmentioning

confidence: 99%

The Haematological Features of Hiv Infection

Bain

1997

Br J Haematol

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“…Na anemia de doença crônica, a eritropoiese é limitada pela hipoferremia. Embora os níveis de eritropoietina estejam elevados, a medula óssea falha na resposta, provavelmente devido às alterações nas funções das citocinas IL-1, IL-3, IL-6, M-CSF, G-CSF, GM-CSF, TNF-RI e TNF-RII (receptores de TNF) 17,18 . Na literatura, é sugerido que a anemia pode estar relacionada ao efeito citopático do HIV-1 sobre os eritróci-tos, às alterações nas células do estroma medular 19 , à presença de anticorpos antieritrócitos 20 ou não 21 , e à infecção das células progenitoras hematopoiéticas pelo HIV-1 22,23 , ou não 24 .…”

Section: Discussionunclassified

Aspectos clínicos e o hemograma em crianças expostas ao HIV-1: comparação entre pacientes infectados e soro-reversores

Silva¹,

Grotto²,

Vilela³

2001

J. Pediatr. (Rio J.)

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Artigo submetido em 14.08.00, aceito em 17.07.01. ResumoObjetivo: analisar evolutivamente aspectos clínicos e hematológicos de crianças expostas à transmissão vertical do HIV-1 e comparar as que se infectaram com aquelas que não se infectaram, ou soro-reversoras.Métodos: trata-se de estudo prospectivo, descritivo, longitudinal. Foram analisadas 79 crianças, filhas de mães infectadas pelo HIV-1, sob seguimento entre março de 1996 a novembro de 1997, no Ambulatório de Imunodeficiência do Hospital de Clínicas da Unicamp.Resultados: houve comprometimento pôndero-estatural em ambos os grupos, sendo maior nos soro-reversores. No grupo das crianças infectadas, 23 mães não fizeram terapia com AZT na gestação, 16 pacientes (61,5%) foram amamentados ao seio, quatro foram classificadas na categoria clínica N, sete na A, e 15 na B. Manifestações clínicas antes de um ano de idade ocorreram em 18 lactentes (69,2%). Anemia se manifestou em 73,1% das crianças infectadas, e em 41,5% das com soro-reversão (p<0,008). A comparação entre os grupos mostrou que as alterações mais freqüentes nos infectados foram microcitose e hipocromia (p<0,05), linfopenia entre 15 e 18 meses (p<0,05), monocitose entre os 9 e 12 meses (p<0,05) e uma tendência de altos níveis séricos de ferritina, mas sem significância estatística.Conclusões: anemia microcítica e hipocrômica ocorreu em ambos os grupos, sendo ferropriva entre os soro-reversores, e anemia de doença crônica, entre os infectados. Nesse referido grupo, monocitose e linfopenia foram manifestações precoces. AbstractObjective: to analyze the evolution of clinical and hematological aspects of children exposed to the vertical transmission of HIV-1, comparing infected patients with uninfected ones or seroreverters.Methods: prospective, descriptive, longitudinal study. We analyzed 79 children born from HIV-1 infected mothers, under clinical follow up from March, 1996 until November, 1997, at the Immunodeficiency division of the Hospital de Clínicas da Unicamp (State University Hospital of Campinas).Results: failure to thrive was observed in both groups, but was greater among seroreverters. Among the infected children, 23 mothers did not use AZT during pregnancy, 16 of them (61.5%) had been breastfed, four were classified into clinical category N, seven into A and fifteen into B. Clinical manifestations in patients younger than one year were seen in 18 infected children (69.2%). Anemia was observed in 73.1% of the infected group and in 41.5% of the seroreverters (P<0.008). The comparison between the groups showed that the most common hematologic alterations in the infected children was microcytosis and hypochromia (P<0.05), lymphopenia between 15 and 18 months (P<0.05), monocytosis between 9 and 12 months (P<0.05) and a tendency towards high ferritin levels, with no statistical significance.Conclusions: microcytic and hypochromic anemia were observed in both groups: iron deficiency in the uninfected children, and chronic disease anemia in the infected ones. The infected children presented with mon...

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Inadequate Erythropoietin Response to Anaemia in HIV Patients: Relationship to Serum Levels of Tumour Necrosis Factor‐Alpha, Interleukin‐6 and Their Soluble receptors

Cited by 52 publications

References 16 publications

Evolution of hematological parameters in a group of children with human immunodeficiency virus infection - HIV 1

Evolution of hematological parameters in a group of children with human immunodeficiency virus infection - HIV 1

The Haematological Features of Hiv Infection

Aspectos clínicos e o hemograma em crianças expostas ao HIV-1: comparação entre pacientes infectados e soro-reversores

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