TABLE 3.
Prospective observational studies of anemia, iron status, and TB-related outcomes among adults with HIV infection1
| Study | Sample size | Female, % | Mean age | Country | Baseline anemia, % | ART use, % | Outcome | Exposures | Exposure categories | Result estimate (95% CI) | Confounders adjusted for |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Isanaka, 2012 (60) | 362 | NR | NR | Tanzania | NR | NR | TB treatment failureTB recurrence | Ferritin, μg/LFerritin, μg/L | <30/30–150/>150<30/30–150/>150 | RR: 1.95 (1.07, 3.52)/1.00/1.54 (1.00, 2.39)RR: 4.21 (1.22, 14.6) 1.00/2.43 (0.93, 6.34) | Sex, age, money spent on food, number of colonies in AFB culture, Karnofsky score, BMI, history of TB disease, HIV infection status, CD4 T-cell count (cells/μL) and log HIV RNA (copies/mL), trial regimen and CRP (mg/L). |
| Isanaka, 2012 (66) | 417 | NR | NR | Tanzania | NR | NR | TB treatment failure | Hemoglobin, g/L and ferritin, μg/L | No anemia, no ID | RR: 1.00 | Sex, age, food expense, number of colonies in AFB culture, Karnofsky score, BMI, previous TB disease, HIV, CD4, log HIV RNA, malaria infection, and trial regimen. |
| ID, no anemia | 3.28 (0.91, 11.9) | ||||||||||
| Anemia, no ID | 2.51 (0.78, 8.05) | ||||||||||
| IDA | 1.78 (0.52, 6.13) | ||||||||||
| TB recurrence | Hemoglobin, g/L and ferritin, μg/L | No anemia, no ID | RR: 1.00 | ||||||||
| ID, no anemia | 2.11 (0.36, 12.5) | ||||||||||
| Anemia, no ID | 6.68 (2.50, 17.8) | ||||||||||
| IDA | 3.81 (1.26, 11.6) | ||||||||||
| McDermid, 2013 (72) | 1139 | 57 | 34.7 | Gambia | NR | 0 | Incident TB | Transferrin, g/L | Continuous | IRR: 0.53 (0.33, 0.84) | Sex, age, CD4, BMI, ethnicity |
| TSat, % | Continuous | IRR: 1.00 (0.99, 1.01) | |||||||||
| Ferritin, μg/L | Continuous | IRR: 1.26 (1.05, 1.51) | |||||||||
| Hemoglobin, g/L | Continuous | IRR: 0.88 (0.79, 0.98) | |||||||||
| Iron, μmol/L | Continuous | IRR: 0.96 (0.92, 1.01) | |||||||||
| sTfR, nmol/L | Continuous | IRR: 1.00 (0.99, 1.01) | |||||||||
| Minchella, 2014 (73) | 196 | 55 | 34.3 y | Gambia | 79 | 0 | Incident TB | Hepcidin | Continuous | IRR: 1.93 (0.67, 5.54) | Age, sex, BMI, CD4, α1 chymotrypsin |
| Mupfumi, 2018 (74) | 300 | 64 | 36 y | Botswana | NR | Baseline: 0 | Incident TB | Hemoglobin, g/L | ≥80 g/L | HR: 1.00 | Age, sex, BMI, CD4 |
| Initiating ART | <80 g/L | 6.88 (1.78, 26.6) | |||||||||
| Tenforde, 2015 (75) | 332 | 47 | 35 y | Nine countries – including Malawi, India, Zimbabwe | NR | 100 | Incident TB, 96 wk follow-up | Hemoglobin, g/L | No anemia | OR: 1.00 | Age, sex, treatment, study site, baseline CD4, viral load |
| Anemia | 2.16 (1.07, 4.35) | ||||||||||
| Ferritin, μg/L | ≤150 | OR: 1.00 | |||||||||
| >150 | 1.72 (0.92, 3.21) | ||||||||||
| Wisaksana, 2013 (76) | 127 | 9 | 29 y | Indonesia | 38 | 67% | Incident TB | Hepcidin, nM | Cases, mean | 9.9 (5.0, 18.2) | Matched controls for age, sex, and CD4 count |
| Controls, mean | 7.2 (2.9, 10.2) | ||||||||||
| Ferritin, μg/L | Cases, mean | 681 (245, 1439) | |||||||||
| Controls, mean | 297 (175, 462) | ||||||||||
| sTfR, mg/L | Cases, mean | 1.4 (1.1, 2.2) | |||||||||
| Controls, mean | 1.4 (1.2, 1.9) | ||||||||||
| Iron, μmol/L | Cases, mean | 7.0 (5,0, 11.0) | |||||||||
| Controls, mean | 10.5 (6.3, 17.5) | ||||||||||
| TIBC, μmol/L | Cases, mean | 39.0 (38.0, 54.0) | |||||||||
| Controls, mean | 51.0 (43.3, 59.8) | ||||||||||
| TSat, % | Cases, mean | 16.0 (12.0, 27.0) | |||||||||
| Controls, mean | 24.0 (14.5, 31.3) | ||||||||||
| MCV, fL | Cases, mean | 83.5 (80.3, 92.5) | |||||||||
| Controls, mean | 85.5 (82.0, 93.8) | ||||||||||
| MCH, pg | Cases, mean | 29.0 (26.3, 32.0) | |||||||||
| Controls, mean | 29.0 (28.0, 32.0) |
1
AFB, acid-fast bacteria; ART, antiretroviral therapy; CRP, C-reactive protein; ID, iron deficiency; IDA, iron deficiency anemia; IRR, incidence rate ratio; MCH, mean corpuscular hemoglobin; MCV, mean corpuscular volume; NR, not reported; sTfR, soluble transferrin receptor; TB, tuberculosis; TIBC, total iron binding capacity; TSat, transferrin saturation.