Circulating cytokines in pulmonary tuberculosis according to HIV status and dietary iron content
Abstract:OBJECTIVE: To evaluate human immunodeficiency virus (HIV) serology, dietary iron and serum concentrations of markers of T-helper type (Th) 1 and Th-2 immune pathways in the setting of tuberculosis (TB).
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: October 1, 2009
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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