Pathogenesis of Anemia during Human Immunodeficiency Virus Infection

Semba, Richard D.; Gray, Glenda

doi:10.2310/6650.2001.33967

Cited by 68 publications

(56 citation statements)

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“…Anaemia was also found to be associated with perinatal MTCT after adjusting for treatment group and HIV RNA viral load. In sub-Saharan Africa, the prevalence of maternal anaemia is higher than in developed countries [31] and is commonly caused by micronutrient deficiencies, sickle-cell disease, malaria, hookworm and other infections including HIV [32,33]. Mechanisms by which anaemia may increase MTCT could include non-specific immune deficiency associated with iron deficiency [34,35], and higher shedding of HIV in blood, breast milk or lower genital tract secretions, as has been described for low serum retinol [9,10,36] and selenium levels [37].…”

Section: Discussionmentioning

confidence: 99%

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. MethodsA total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. ResultsThere were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P 5 0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P 5 0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P 5 0.006] and anaemia (haematocrit o33%; AOR 7.5; 95% CI 1.7-32.4; P 5 0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P 5 0.034). ConclusionsIPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.Keywords: anaemia, intermittent preventive treatment, mother-to-child transmission, placental malaria, pregnancy Received: 18 February 2008, accepted 15 May 2008 Introduction HIV/AIDS and malaria infections are two of the most important global health problems of our time, and strongly overlap in sub-Saharan Africa [1]. The detrimental effects of this interaction may be especially relevant during pregnancy, with adverse outcomes for both the mother and the infant [2,3].Vertical transmission of HIV occurs at an approximate rate of 25-40% in untreated breast feeding populations [4,5]. Maternal RNA viral load [2,6,7] [6,7,11], it has been suggested that malaria, by increasing the replication of HIV, may increase the risk of MTCT [2,6]. However, studies assessing the impact of placental malaria (PM) on MTCT have produced conflicting results, suggesting either that PM could increase MTCT or that low-density PM parasitaemia could decrease MTCT [6,7,17,18]. Pregnant women are especially susceptible to malaria infection, which is associated with considerable maternal and infant morbidity and mortality. The World Health Organization recommends that pregnant women in stable transmission areas receive intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and sleep under insecticide-treated nets (ITNs). However, the efficacy of the concomitant use of these two interventions has not been evaluated. IPTp consists of the provision of two doses, at le...

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Section: Discussionmentioning

confidence: 99%

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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“…17 Our study showed decreased anemia with HAART use, which supports data from prior studies. 6,13,24,26,27 Studies by Moore and Forney 26 and by Semba and others 27 found that HAART was an effective treatment for anemia of HIV infection, and the potential mechanisms that might be involved included a reduction in opportunistic infections and the anemia of chronic disease, and an improvement in nutritional status.…”

Section: Discussionmentioning

confidence: 99%

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Masaisa¹,

Gahutu²,

Mukiibi³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. To determine the prevalence and risk factors of anemia among human immunodeficiency virus (HIV)-infected women in Rwanda and the influence of highly active antiretroviral therapy (HAART) on anemia, we analyzed 200 HIV-positive women and 50 HIV-negative women in a cross-sectional study. Clinical examinations and iron and vitamin B 12 assays were performed, and complete blood counts, serum folic acid levels, and CD4 cell count determined. The prevalence of anemia was significantly higher among HIV-positive women (29%) than among HIV-negative women (8%) ( P < 0.001). Risk factors for anemia were lower body mass index (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 2.4-4.1), zidovudine use (OR = 1.14, 95% CI = 1.01-1.29), lack of HAART (OR = 1.44, 95% CI = 1.21-1.67), oral candidiasis (OR = 1.4, 95% CI = 1.2-1.6), pulmonary tuberculosis (OR = 1.8, 95% CI = 1.7-2.2), cryptococcal meningitis (OR = 1.6, 95% CI = 1.21-1.8), Pneumocystis jiroveci pneumonia (OR = 1.41, 95% CI = 1.20-1.65) and CD4 lymphocyte count < 200 cells/µL (OR = 2.41, 95% CI = 2.01-3.07). The mean ± SD hemoglobin level of 10.9 ± 1.6 g/dL at HAART initiation significantly increased to 12.3 ± 1.5 g/dL in 8 months ( P < 0.001). Anemia increases with HIV stage, and HAART is associated with a significant improvement in hemoglobin levels.*Address correspondence to Jean Bosco Gahutu, Faculty of Medicine, National University of Rwanda, PO Box 30, Huye, Rwanda. E-mail: jgahutu@nur.ac.rw 457 ANEMIA IN HIV-INFECTED AND UNINFECTED WOMEN, RWANDA level < 11.5 mg/dL by using reference ranges based upon local control measurements in our laboratory, which is located at a moderate altitude of 1,768 meters. This limit was also shown by Beutler and Waalen. 20 Serum iron, vitamin B 12 , and folic acid levels were measured in the clinical laboratory of Ghent University Hospital. However, erythropoietin assays and the screening for malaria and chronic helminthes were not systematically conducted.The first-line HAART regimen at the time of the study consisted of stavudine or zidovudine, plus lamivudine, plus nevirapine or efavirenz; more patients used stavudine and nevirapine than zidovudine and efavirenz. For all the patients who initiated HAART at the time of entry into the study, they were all given a stavudine-based regimen. No patients were taking other antiretroviral medications such as tenofovir, abacavir, or protease inhibitors. Women receiving zidovudine for prevention of mother-to-child transmission of HIV were not included in the study population.Most patients were given cotrimoxazole prophylaxis with a dose of 1 tablet of 960 mg daily when CD4 cell counts were less than 350 cells/μL when possible. However, because many patients initially only sought care when they have reached advanced stages of immunosuppression, some patients were given prophylaxis at lower CD4 cell counts. No persons were offered ferrous sulfate and/or multivitamins for the treatment of anemia.Statistical analysis. All statistical analyses were performed with SPSS software ...

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“…However, among anemic women, TfR concentrations were significantly lower among APRpositive compared to APR-negative women. This may reflect suppression of erythropoeisis caused by pro-inflammatory cytokines such as IL-1, IL-6 and TNF-a, which result in increased AGP concentration (Gabay and Kushner, 1999;Fournier et al, 2000) and are also known to be associated with HIV-infection (Semba and Gray, 2001). These proinflammatory cytokines can interact with the hematopoietic system at several levels, resulting in impaired erythropoeisis.…”

Section: Discussionmentioning

confidence: 99%

“…We, therefore, believe that impaired bone marrow response to EPO stimulation, rather than EPO production, is the likely cause of the observed decrease in TfR concentration among APR-positive women. Possible mechanisms include circulating pro-inflammatory cytokines directly impairing bone marrow response to EPO stimulation and impaired proliferation of erythroid progenitor cells (Spivak, 2000;Weiss and Goodnough, 2005), or from direct HIV infection of hematopoietic stem cells, progenitor cells and/or bone marrow stromal cells (Semba and Gray, 2001).…”

Section: Discussionmentioning

confidence: 99%

Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

et al. 2008

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Pathogenesis of Anemia during Human Immunodeficiency Virus Infection

Cited by 68 publications

References 194 publications

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

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Pathogenesis of Anemia during Human Immunodeficiency Virus Infection

Cited by 68 publications

References 194 publications

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*