|Year : 2007 | Volume
| Issue : 1 | Page : 23-25
Estimation of serum ferrium in HIV/AIDS patients
Jeyakumar Williams, S Jeevithan, D Thirunavukkarasu, V Ravichandran, S Suganya
Department of Skin and STD, Vinayaka Mission College, GMKMCH, Salem, India
4/169, Immanuel Cottage, Thasildhar Nagar, Madurai - 625 020
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Serum iron was estimated in 105 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients, 20 HIV-negative sexually transmitted disease (STD) patients and 25 voluntary healthy controls. Twenty-two clinical AIDS patients, 8 immunological AIDS patients, 2 HIV seropositive and 8 non-HIV STD controls had serum iron <60 mg/dl (Hb: <10 gm). Two clinical AIDS patients and two non-HIV STD controls showed serum iron level >161 µg/dl (Hb: 12-14 gm). Anemia was prevalent in AIDS cases, and the study of survival period may be unfolded in follow-up. Bone marrow biopsy could not be performed to identify the suppression of hemopoiesis in 4 patients, who showed >161 mg/dl of serum iron. Study of iron supplementation and long-term follow-up are necessary to unfold the risks and benefits of iron supplementation in HIV/AIDS patients.
Keywords: HIV/AIDS Patients, Ferrium
|How to cite this article:|
Williams J, Jeevithan S, Thirunavukkarasu D, Ravichandran V, Suganya S. Estimation of serum ferrium in HIV/AIDS patients. Indian J Sex Transm Dis 2007;28:23-5
|How to cite this URL:|
Williams J, Jeevithan S, Thirunavukkarasu D, Ravichandran V, Suganya S. Estimation of serum ferrium in HIV/AIDS patients. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 13];28:23-5. Available from: http://www.ijstd.org/text.asp?2007/28/1/23/35707
| Introduction|| |
Micronutrients are the essential trace elements which are necessary in small quantities for the human body's vital activities. Essential trace elements are iron, zinc, selenium, magnesium, copper, chromium, iodine and cobalt. Iron is an essential nutrient for the formation of hemoglobin. Out of the total iron, two-thirds is present in the form of hemoglobin.
Hematological abnormalities are the most common complications in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. In HIV infection, anemia is common and has been shown to be a significant predictor of progression of HIV to AIDS and is independently associated with increased risk of death.  Pathogenesis of anemia in HIV infection may be due to chronic disease, opportunistic infection, HIV itself, nutritional deficiency or malaria.
Iron and binding protein have immuno-regulatory properties, and shifting of immuno-regulatory balance by iron deficiency or excess may precipitate severe deleterious physiological effects. Progressive iron loading in excess may have negative effects in individuals with HIV.  Iron metabolism is an important area for virus-host interaction. DNA phase of HIV life cycle requires chelatable iron for optimum replication. 
The main cause of iron loading is the chronic inflammatory response that involves iron withholding and is accompanied by retention of iron in the reticuloendothelial system.  The progression of HIV 1 infection towards more advanced stages is accompanied by changes in iron metabolism and increased body iron stores.  Iron is an oxidant as well as a nutrient for invading microbes and neoplastic cells, facilitating replication and survival of microbial pathogens.  Iron excess results in decreased defense activity of polymorphonuclear granulocytes, macrophages, resulting in an impaired cell mediated immunity.  Hemoglobin, hemoglobin electrophoresis, ferritin, serum erythropoietin, serum iron, transferrin, red cell concentration and serum ferritin are the available tools to find out the quantity of iron.
Iron intake either through parenteral or alimentary route should not be encouraged as a routine in HIV/AIDS patients, since the course of HIV can be accelerated by iron loading in them.
| Materials and Methods|| |
In this study, serum iron in 105 HIV/AIDS patients, along with 20 non-HIV STD disease controls and 25 voluntary controls, was estimated. Thirteen male and 11 female clinical AIDS patients; 5 male and 5 female immunological AIDS patients; 26 male and 45 female HIV seropositives; 13 male and 7 female non-HIV STD controls; and 10 male and 15 female voluntary controls were screened for a period from August 2005 to July 2006. All the patients and volunteers were counseled individually about this study. Informed consent was obtained from all the attendees. Ethics committee clearance was obtained. All cases were subjected to investigations like urine routine and microscopy, chest X-ray, sputum AFB, Mantoux test, hemogram, S. VDRL, blood sugar, urea, S. creatinine, S. iron. CD4 count was estimated in a few cases. Ophthalmological screening was carried out in all cases.
Five milliliters of blood was collected from the patients; serum was separated from the sample by centrifugation method. The separated serum was tested for the estimation of iron on the same day. Four dry, clear test tubes were taken and labeled as Blank (B), Standard (S), Sample blank (SB) and Test (T). One milliliter of iron buffer reagent (L1) was pipetted into B, S, T test tubes and 1.05 ml into the sample blank test tube. Distilled water (0.2 ml) was added into the blank test tube, and 0.2 ml of iron standard was added into the standard test tube. Test samples of 0.2 ml were added into the S, B and T labeled test tubes. Iron color reagent (0.05 ml) was added into the blank and standard test tubes. All the test tubes were mixed well and incubated at room temperature for 5 min. Absorbance of the blank (Abs B), standard (Abs S), sample blank (Abs SB) and test samples (Abs T) was taken against distilled water by analyzer, and the results were collected and calculated.
Iron in micrograms/deciliter =
| Results|| |
[Table - 1] shows the number and percentage of patients screened.
Twelve male (50%) and 10 female (41.6%) clinical AIDS patients; 4 male (40%) and 4 female (40%) immunological AIDS patients; 1 male (3.8%) and 1 female (2.2%) HIV seropositives; 5 male (38.5%) and 3 female (42.85%) non-HIV STD controls; 1 male (10%) and 1 female (6.7%) voluntary controls had less than 60 mg/dl of serum iron (anemic).
Only 1 male (10%) and 1 female (10%) immunological AIDS patients; 25 male (96.2%) and 44 female (97.7%) HIV seropositives; 7 male (53.8%) and 3 female (42.85%) non-HIV STD controls; 9 male (90%) and 14 female (93.3%) voluntary controls had serum iron levels in between 61 and 160 mg/dl (not anemic).
Only one male (4.2%) and one female (4.2%) clinical AIDS patients; one male (7.7%) and one female (14.30%) non-HIV STD controls showed serum iron level more than 161 mg/dl (supposed to be high).
| Discussion|| |
Anemia, a frequent complication of HIV infection, is well recognized with increased morbidity and mortality in AIDS;  therefore, the serum iron level in HIV/AIDS patients, along with non-HIV STD and voluntary controls, was estimated.
Fifty percent of male and 41.6% of female clinical AIDS patients; 40% of male and 40% of female immunological AIDS patients; 3.8% of male and 2.2% of female HIV seropositives were anemic in the present study, which simulated the Sullivan's study.  Follow-up in large quantum will unfold the true incidence.
Hematological abnormalities are the commonest clinico-pathological manifestations of AIDS. Decreased hemoglobin level was predictive of decreased survival.  The present study clearly pointed out that anemia was prevalent in AIDS patients. Further large-scale study is necessary to predict any fact, which was not possible to do in this study since it was a small-scale study. Follow-up is necessary to find out the survival period and exact dosing of iron supplementation.
In the present study, 20% of immunological AIDS patients, 97.18% of HIV seropositives, 50% non-HIV STD controls and 92% voluntary controls had serum iron level between 61 and 160 mg/dl, i.e., Hb% level between 12 and 14 gm%. In future, continuous follow-up would be necessary in HIV seropositives to find out the consequences.
The 8.33% clinical AIDS patients and 10.6% non-HIV STD controls showed serum iron level >161 mg/dl, which is supposed to be high. Whether this increased serum iron level was due to iron overloading or not was unclear. Accumulation of iron in macrophages, microglia, endothelial cells and myocytes was not estimated.  Mononuclear-macrophage cells can develop productive HIV infection, and the Transforming Growth Factor beta (TGF b), TNF a, Interleukin I contribute to the suppression of hemopoiesis. 
Bone marrow biopsy to identify fragmented red cells, abnormal and immature red blood cells was not done.
Course of HIV can be accelerated with iron supplementation. Thus the supplementation of iron has led to a dilemma regarding the use of iron for iron deficiency anemia in HIV/AIDS patients.  Study of iron supplementation and long-term follow-up are necessary to unfold this knot.
| Acknowledgement|| |
Our thanks are due to ICMR, New Delhi, for sponsoring this project. We are also thankful to Mr. P. Sakthivel (Counselor) and Mr. S. L. Radhakrishnan (Peer educator).
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[Table - 1]