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Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi

European Journal of Clinical Nutrition volume 59, pages 526–532 (2005)Cite this article

Abstract

Background:

Although anemia is common among adults with pulmonary tuberculosis and human immunodeficiency virus (HIV) infection in sub-Saharan Africa, the factors contributing to its pathogenesis have not been well characterized.

Objective:

To characterize the antioxidant micronutrient status, interleukin-6 (IL-6) concentrations, and HIV load in relationship with anemia in adults with pulmonary tuberculosis.

Setting:

Zomba district, Malawi.

Methods:

Erythropoietin, IL-6, plasma HIV load, and markers of micronutrient status (hemoglobin (Hb), plasma concentrations of retinol, α-tocopherol, carotenoids, ferritin, zinc, and selenium) were measured in 500 adults who presented with pulmonary tuberculosis in Zomba Central Hospital, Malawi.

Results:

Among 370 HIV-positive and 130 HIV-negative adults, the prevalence of anemia was 88 and 77%, respectively (P=0.002), and moderate to severe anemia (Hb<80 g/l) occurred in 30 and 15%, respectively (P=0.001). Geometric mean IL-6 concentration was 21.1 pg/ml, with no difference between HIV-positive and -negative adults. The erythropoietin response to anemia was not different between adults with elevated IL-6 and those with lower IL-6 concentrations. In a multivariate logistic regression model, HIV load, and lower plasma selenium concentrations were associated with moderate to severe anemia. In a final multivariate linear regression model, IL-6, plasma HIV load, and plasma selenium concentrations were associated with Hb concentrations.

Conclusion:

This study suggests that low selenium concentrations, high HIV load, and high IL-6 concentrations are associated with anemia in adults with pulmonary tuberculosis in sub-Saharan Africa.

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Acknowledgements

This work was supported in part by the National Institutes of Health (AI41956) and the Fogarty International Center. We thank Dr Karen Near and Dr Barbara Laughon at the National Institute of Allergy and Infectious Diseases for their continuing support. We thank Dana Totin Moncrief, Barbara Dancheck, Amanda Ray, and Michelle Ricks for their contributions to laboratory and data analyses.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, USA

    M van Lettow & R D Semba

  2. Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, The Netherlands

    C E West

  3. Radboud University Nijmegen Medical Centre, The Netherlands

    J W M van der Meer & F T Wieringa

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  1. M van Lettow
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  2. C E West
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  3. J W M van der Meer
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  4. F T Wieringa
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  5. R D Semba
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Correspondence to M van Lettow.

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Guarantors: M van Lettow, RD Semba.

Contributors: MvL has been in charge of the collection and analysis of data and writing of the manuscript. Provision of significant advice and consultation was given by CEW, JWMvdM, FTW and RDS.

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van Lettow, M., West, C., van der Meer, J. et al. Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi. Eur J Clin Nutr 59, 526–532 (2005). https://doi.org/10.1038/sj.ejcn.1602116

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