Sickle cell disease is associated with decreased HIV but higher HBV and HCV comorbidities in US hospital discharge records: a cross-sectional study

Abstract

Objective Some studies suggest that HIV infection progresses slowly in patients with sickle cell disease (SCD). The authors aimed to determine the relationships between SCD and HIV infection. Methods National Hospital Discharge Survey data from adult Africane–Americans in the period of 1997–2009 were analysed. The comorbidities of SCD with HIV infections in hospital discharges were analysed. Multiple logistic regression was used to test the association between SCD and HIV. For comparative purposes, the relationships of SCD with hepatitis B virus (HBV) and hepatitis C virus (HCV) were also assessed. Results 423 431 records were divided into two time periods 1997–2003 (53% of records) and 2004–2009 (47% of records). The frequency of HIV diagnosis was lower in patients with SCD (1.5% vs 3.3% in patients without SCD). In logistic regression, SCD diagnosis was associated with an OR of 0.24 (95% CI 0.18 to 0.32) for HIV diagnosis in the first period and with an OR of 0.31 (95% CI 0.22 to 0.42) in the second period. In contrast, SCD was associated with higher risk of HCV (OR=2.01, 95% CI 1.56 to 2.59 in the first period and OR=2.12, 95% CI 1.71 to 2.63 in the second period). SCD was also associated with a higher risk of HBV (OR=1.15, 95% CI 0.72 to 1.83 in the first period and OR=1.82, 95% CI 1.24 to 2.68 in the second period). Conclusions The lower risk of HIV comorbidity, but not HCV and HBV, with SCD is consistent with the possibility that SCD has a unique effect in altering the risk of HIV infection or progression. Investigation of how the haemolytic and immunological changes of SCD influence HIV might lead to new therapeutic or preventive approaches.

Incidence of Human Immunodeficiency Virus in Sickle Cell Patients in the Cape Coast Metropolis, Ghana

“…SCD is associated with upregulated inflammatory and haemolytic pathways which lead to the suggestion that the disease may influence the course of HIV infection and progression [6] [8]. However, Nouraie et al (2012) reported 1.5% HIV diagnosis in adult African Americans with sickle cell diseases as against 3% in those without disease [18]. It may be possible that the lower risk of HIV co-morbidity with SCD may present a unique effect that alters the risk of HIV infection or progression.…”

A Cryptic Polyreactive Antibody Recognizes Distinct Clades of HIV-1 Glycoprotein 120 by an Identical Binding Mechanism

“…The inhibitory effect of heme was proposed to be either due to direct interaction with the reverse transcriptase (72,73) or through indirect effects of heme on host cells (such as up-regulation of heme oxygenase-1) (69 -71). Importantly, a recent analysis that includes more than 400,000 patients with sickle cell anemia, a condition accompanied by high levels of intravascular hemolysis and heme release, demonstrated a 70% lower incidence of HIV-1 infection as compared with the normal population (74). In contrast, the incidence of other viral infections, such as hepatitis C virus and hepatitis B virus, was elevated, suggesting a specific protective effect of hemolytic disorders on HIV-1 infection.…”

Prevalence and Gene Characteristics of Antibodies with Cofactor-induced HIV-1 Specificity

“…It is noteworthy that HIV-1 has high sensitivity to heme, which has been explained by different mechanisms (48,(62)(63)(64)(65). Accordingly, a recent clinical study has revealed that the incidence of HIV-1 infection in patients with sickle cell disease, who might have intravascular hemolysis and release of free heme, is significantly lower as compared with the normal population (66). Our data suggest that the fraction of cofactor-binding Abs might also contribute to the documented inhibitory effect of heme on HIV-1.…”