Circulating cytokines in pulmonary tuberculosis according to HIV status and dietary iron content
METHODS: A total of 49 patients with pulmonary TB in rural Zimbabwe, 32 of whom were HIV-positive, were evaluated at presentation and over 10 weeks of anti-tuberculosis treatment.
RESULTS: Interleukin (IL) 12 and neopterin, Th-1 markers, were both elevated at presentation in 92% of the subjects. In contrast, only 23% had elevation of the Th-2 marker, IL-4. Neopterin and IL-6 concentrations decreased over 10 weeks of treatment (P ≤ 0.005), but IL-12 and NO2/NO3 increased (P ≤ 0.012). IL-12 and neopterin concentrations were higher in HIV-positive subjects compared to HIV-negative subjects (P < 0.0001), while IL-4 concentrations were lower (P = 0.001). Patients were classified as having high vs. normal dietary iron based on the consumption of iron-rich traditional beer. IL-12 and NO2/NO3 concentrations were lower with high dietary iron (P ≤ 0.002). HIV-positive individuals with high dietary iron had lower neopterin concentrations compared to HIV-positive individuals with low dietary iron (P < 0.0001).
CONCLUSION: Increased iron in pulmonary TB may lead to attenuation of the Th-1 immune response, especially with HIV seropositivity. Iron status may be an important but under-evaluated risk factor in the course of TB and HIV infection.
Document Type: Regular Paper
Affiliations: 1: Center for Sickle Cell Disease and Department of Medicine, Howard University, Washington, DC, USA 2: Merrimack Pharmaceuticals, Cambridge, Massachusetts, USA 3: Department of Medicine, University of Zimbabwe, Harare, Zimbabwe 4: Nyadire Mission Hospital, Mutoko, Zimbabwe 5: Department of Chemical Pathology, University of Zimbabwe, Harare, Zimbabwe 6: Department of Medicine, Algemeen Ziekenhuis St Jan, Bruges, Belgium 7: Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
Publication date: 2009-10-01
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