The impact of antiretroviral therapy on iron homeostasis and inflammation markers in HIV-infected patients with mild anemia

Background: Anemia is frequent in HIV infection and is predictive of mortality, and antiretroviral therapy (cART) not always resolve it. We aimed to study iron homeostasis and inflammation evolution in patients with mild anemia in relation to cART.
Methods: retrospective cohort study including HIV-infected patients with mild anemia, CD4+ cells >200/mm3 who started cART (T0), and divided on the basis of recovery (group A) or not (group B) of anemia after 12 months of efficient cART (T1) (hemoglobin value >13 or <13 gr/dL, respectively). We measured several inflammation markers and iron homeostasis indexes in stored samples. Results: cART significantly improved CD4+ and CD8+ cell counts and their ratio only in group A. These patients had mild iron deficiency, higher transferrin and lower percentage of transferrin saturation at T0 than B (differences disappeared with cART). cART decreased inflammation in all patients, but group B had higher levels of all markers, reaching statistical significance only for IL-8 at T1. They moreover have hepcidin and IL-6 levels lower at T0, but no at T1. Hemoglobin levels, both at T0 and T1, did not correlate with any marker.
Conclusions: mild anemia cannot always be resolved with efficient cART, possibly due to residual inflammation or immune activation rather than unbalanced iron homeostasis. Further research is needed to understand the mechanisms that induce anemia in HIV with suppressive cART.

Alice Ferraresi
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