Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
HIV Med. 2023 Apr;24(4):398-410. doi: 10.1111/hiv.13396. Epub 2022 Sep 8.
The influence of inflammation on iron status among people living with HIV (PLWHIV) has not been well explored. We evaluated the trajectory of iron status among PLWHIV during the first year of highly active antiretroviral therapy (HAART), compared alternative approaches for inflammation correction, and assessed the associations of iron status with HIV-1 viral load and anthropometric outcomes.
We conducted a secondary analysis of data from a randomized trial among 400 adults initiating HAART in Tanzania. Ferritin and C-reactive protein (CRP) were measured at baseline, 1, 6 or 12 months. Ferritin was considered in four ways: unadjusted, and adjusted for inflammation using higher cut-off (HC), Thurnham-corrected (TC) and regression-corrected (RC) approaches. For unadjusted, TC and RC ferritin, iron deficiency (ID) was defined using ferritin < 15 μg/L and elevated iron status was defined using ferritin > 150 μg/L among females and > 200 μg/L among males. For HC ferritin, elevated iron status was defined based on serum ferritin > 500 μg/L, while ID was defined using ferritin < 70 μg/L in the presence of inflammation and < 15 μg/L in the absence of inflammation. Regression models evaluated the trajectory of ferritin concentration across categories of baseline characteristics, and assessed the association of iron status with viral and anthropometric outcomes.
The prevalence of iron deficiency at HAART initiation was 9% for unadjusted, 17% for HC, 12% for TC and 22% for RC ferritin. The prevalence of elevated iron status was 42% for unadjusted, 18% for HC, 31% for TC, and 15% for RC ferritin. The prevalence of iron deficiency for all three methods increased during the first year of HAART, while the prevalence of elevated iron status decreased. Baseline elevated iron status defined using HC ferritin was associated with a greater risk of HIV-1 viral load > 1000 copies/mL [relative risk (RR) = 4.29, 95% CI: 1.38-13.3] and incidence of being underweight [body mass index (BMI) < 18.5 kg/m , hazard ratio (HR) = 3.65, 95% confidence interval (CI): 1.38-9.67]. Neither baseline-elevated iron status defined using TC or RC ferritin nor baseline iron deficiency defined using any of the three methods was associated with HIV-1 viral load or anthropometric outcomes.
Whether and how inflammation correction is done influences findings of studies of iron status among PLWHIV.
炎症对 HIV 感染者（PLWHIV）铁状态的影响尚未得到充分探索。我们评估了在高效抗逆转录病毒治疗（HAART）的第一年中 PLWHIV 铁状态的变化轨迹，比较了纠正炎症的替代方法，并评估了铁状态与 HIV-1 病毒载量和人体测量结果的关联。
我们对坦桑尼亚 400 名开始接受 HAART 的成年人进行的一项随机试验中的数据进行了二次分析。在基线、1、6 或 12 个月时测量铁蛋白和 C 反应蛋白（CRP）。铁蛋白以四种方式考虑：未经调整，以及使用较高截距（HC）、Thurnham 校正（TC）和回归校正（RC）方法进行炎症校正。对于未经调整、TC 和 RC 铁蛋白，铁缺乏症（ID）定义为女性铁蛋白 <15μg/L，男性铁蛋白 <200μg/L，而铁状态升高定义为女性铁蛋白 >150μg/L，男性铁蛋白 >200μg/L。对于 HC 铁蛋白，铁状态升高定义为血清铁蛋白 >500μg/L，而炎症时铁蛋白 <70μg/L，无炎症时铁蛋白 <15μg/L 时定义为 ID。回归模型评估了基线特征类别中铁蛋白浓度的变化轨迹，并评估了铁状态与病毒和人体测量结果的关联。
HAART 起始时未经调整的铁缺乏症患病率为 9%，HC 为 17%，TC 为 12%，RC 为 22%。未经调整的铁状态升高的患病率为 42%，HC 为 18%，TC 为 31%，RC 为 15%。所有三种方法的铁缺乏症患病率在 HAART 的第一年都有所增加，而铁状态升高的患病率则下降。使用 HC 铁蛋白定义的基线铁状态升高与 HIV-1 病毒载量 >1000 拷贝/mL 的风险增加相关[相对风险（RR）=4.29，95%置信区间（CI）：1.38-13.3]和体重不足的发生率[身体质量指数（BMI）<18.5kg/m 2 ，风险比（HR）=3.65，95%置信区间（CI）：1.38-9.67]。使用 TC 或 RC 铁蛋白定义的基线铁状态升高，以及使用三种方法中的任何一种定义的基线铁缺乏症均与 HIV-1 病毒载量或人体测量结果无关。
炎症校正的方式和方法会影响 PLWHIV 铁状态研究的结果。
