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https://www.arca.fiocruz.br/handle/icict/56010
ASSOCIATION BETWEEN SEVERE ANAEMIA AND INFLAMMATION, RISK OF IRIS AND DEATH IN PERSONS WITH HIV: A MULTINATIONAL COHORT STUDY
Author
Affilliation
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica. Rio de Janeiro, RJ, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Fundação Bahiana para o Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
Clinical Monitoring Research Program Directorate. Frederick National Laboratory for Cancer Research. Frederick, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
Kenya Medical Research Institute. Henry Jackson Foundation Medical Research International. Bethesda, MD, USA / Walter Reed Army Institute of Research/US Army Medical Research Directorate-Africa. Nairobi, Kenya.
Southeast Asia Research Collaboration with Hawaii. Henry M. Jackson Foundation for the Advancement of Military Medicine. United States Military HIV Research Program. Bethesda, MD, USA.
SEARCH. Institute of HIV Research and Innovation. Bangkok, Thailand.
Kenya Medical Research Institute. Henry Jackson Foundation Medical Research International. Bethesda, MD, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica. Rio de Janeiro, RJ, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica. Rio de Janeiro, RJ, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Fundação Bahiana para o Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil.
Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
Clinical Monitoring Research Program Directorate. Frederick National Laboratory for Cancer Research. Frederick, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
National Institutes of Allergy and Infectious Diseases. National Institutes of Health. Bethesda, MD, USA.
Kenya Medical Research Institute. Henry Jackson Foundation Medical Research International. Bethesda, MD, USA / Walter Reed Army Institute of Research/US Army Medical Research Directorate-Africa. Nairobi, Kenya.
Southeast Asia Research Collaboration with Hawaii. Henry M. Jackson Foundation for the Advancement of Military Medicine. United States Military HIV Research Program. Bethesda, MD, USA.
SEARCH. Institute of HIV Research and Innovation. Bangkok, Thailand.
Kenya Medical Research Institute. Henry Jackson Foundation Medical Research International. Bethesda, MD, USA.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative. Salvador, BA, Brasil / Universidade Federal da Bahia. Programa de Pós-Graduação em Patologia Humana e Experimental. Salvador, BA, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica. Rio de Janeiro, RJ, Brasil / Universidade Salvador. Curso de Medicina. Salvador. BA, Brasil.
Abstract
Background: After initiating antiretroviral therapy (ART), approximately 25% of people with HIV (PWH) may develop Immune Reconstitution Inflammatory Syndrome (IRIS), which is associated with increased morbidity and mortality. Several reports have demonstrated that low haemoglobin (Hb) levels are a risk factor for IRIS. To what extent the severity of anaemia contributes to the risk of IRIS and/or death is still insufficiently explored. Methods: We investigated both the presence and severity of anaemia in PWH in a multinational cohort of ART-naïve patients. A large panel of plasma biomarkers was measured pre-ART and patients were followed up for 6 months. IRIS or deaths during this period were considered as outcomes. We performed multidimensional analyses, logistic regression, and survival curves to delineate associations. Findings: Patients with severe anaemia (SA) presented a distinct systemic inflammatory profile, characterized by higher TNF, IL-6, and IL-27 levels. SA was independently associated with IRIS, with a higher risk of both early IRIS onset and death. Among IRIS patients, those with SA had a higher risk of mycobacterial IRIS. Interpretation: PWH with SA display a more pronounced inflammatory profile, with an elevated risk of developing IRIS earlier and a statistically significant higher risk of death.
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