E-Selectin and markers of HIV disease severity, inflammation and coagulation in HIV-infected treatment-naïve individuals

Background: E-selectin has been shown to play a role in atherosclerosis and to be increased in HIV-infected individuals due to chronic immune activation. There is a paucity of studies on E-selectin in HIV-infected treatment-naïve individuals. Objectives: This study aimed to determine whether E-selectin levels were increased in HIV-infected treatment-naïve individuals and whether these correlated with markers of disease severity, inflammation and coagulation to determine if this population is at risk for cardiovascular disease (CVD).Methods: E-selectin levels were determined in 114 HIV-infected treatment-naive and 66 HIV-negative individuals, compared between groups and correlated with markers of disease severity, inflammation and coagulation.Results: There were statistically significant differences (p<0.01) in levels of WCC, CD4+ count, %CD38/8, albumin, IgG, hsCRP and D-dimer between groups and no statistically significant differences in E-selectin (p=0.84) and fibrinogen (p=0.65) levels. E-selectin correlated with age (p=0.02) and gender (p=0.01). Conclusion: E-selectin was a poor marker in this setting. There was no correlation with any of the markers of disease severity, inflammation and coagulation. E-selectin is most likely raised in an acute inflammatory setting, rather than chronic stage of HIV-infection. We recommend that other markers be utilized to identify patients at increased risk of CVD; as these were significantly increased untreated in individuals.Keywords: E-selectin, inflammation and coagulation in HIV-infected treatment-naïve individuals

E-Selectin and markers of HIV disease severity, inflammation and coagulation in HIV-infected treatment-na\uefve individuals

Background: E-selectin has been shown to play a role in atherosclerosis and to be increased in HIV-infected individuals due to chronic immune activation. There is a paucity of studies on E-selectin in HIV-infected treatment-na\uefve individuals. Objectives: This study aimed to determine whether E-selectin levels were increased in HIV-infected treatment-na\uefve individuals and whether these correlated with markers of disease severity, inflammation and coagulation to determine if this population is at risk for cardiovascular disease (CVD). Methods: E-selectin levels were determined in 114 HIV-infected treatment-naive and 66 HIV-negative individuals, compared between groups and correlated with markers of disease severity, inflammation and coagulation. Results: There were statistically significant differences (p<0.01) in levels of WCC, CD4+ count, %CD38/8, albumin, IgG, hsCRP and D-dimer between groups and no statistically significant differences in E-selectin (p=0.84) and fibrinogen (p=0.65) levels. E-selectin correlated with age (p=0.02) and gender (p=0.01). Conclusion: E-selectin was a poor marker in this setting. There was no correlation with any of the markers of disease severity, inflammation and coagulation. E-selectin is most likely raised in an acute inflammatory setting, rather than chronic stage of HIV-infection. We recommend that other markers be utilized to identify patients at increased risk of CVD; as these were significantly increased untreated in individuals

Iron deficiency:a modern primer to diagnosis and management

PURPOSE OF REVIEW: Iron deficiency with anemia (IDA) and without anemia remain a diagnostic and management challenge. Iron deficiency has a broad spectrum of causes, including gastrointestinal malignancy. The purpose of this review is to summarize the value and limitations of current methods to diagnose iron deficiency and underline the relevance of contemporaneous evidence to guide the pretest probability of gastrointestinal disease. RECENT FINDINGS: A number of biomarkers for iron deficiency exist, and all have their caveats. Serum ferritin remains the most pragmatic means of diagnosing iron deficiency. Hepcidin holds future promise as a marker of iron status during inflammatory states. Men and postmenopausal women with IDA have the highest overall prevalence of gastrointestinal malignancy (∼11%), while premenopausal women with IDA (<1.5%) and those with iron deficiency without anemia (<0.5%) have a very low risk. Noninvasive investigation with fecal immunochemical test and fecal calprotectin hold promise to guide further investigations in lower risk groups. SUMMARY: Confirmation of iron deficiency remains a challenge. Appropriate risk stratification is the key to guiding judicious gastrointestinal investigation. Use of noninvasive tests may play an important role in lower risk groups. Risk prediction tools applicable to relevant populations are required

Iron status in the elderly: a review of recent evidence

A comprehensive literature review of iron status in the elderly was undertaken in order to update a previous review (Fairweather-Tait et al, 2014); 138 papers were retrieved that described research on the magnitude of the problem, aetiology and age-related physiological changes that may affect iron status, novel strategies for assessing iron status with concurrent health conditions, hepcidin, lifestyle factors, iron supplements, iron status and health outcomes (bone mineral density, frailty, inflammatory bowel disease, kidney failure, cancer, cardiovascular, and neurodegenerative diseases). Each section concludes with key points from the relevant papers. The overall findings were that disturbed iron metabolism plays a major role in a large number of conditions associated with old age. Correction of iron deficiency/overload may improve disease prognosis, but diagnosis of iron deficiency requires appropriate cut-offs for biomarkers of iron status in elderly men and women to be agreed. Iron deficiency (with or without anemia), anemia of inflammation, and anemia of chronic disease are all widespread in the elderly and, once identified, should be investigated further as they are often indicative of underlying disease. Management options should be reviewed and updated, and novel therapies, which show potential for treating anemia of inflammation or chronic disease, should be considered

Severe hypercholesterolemia mediated by lipoprotein X in a patient with cholestasis

Lipoprotein X (LpX) is an abnormal lipoprotein associated with cholestasis. It is a significant cause of severe hypercholesterolemia and should always be considered in patients with cholestatic liver disease. This case highlights the significance of LpX as a cause of severe hypercholesterolemia in a patient with cholestasis secondary to a granulomatous hepatitis attributed to tuberculosis. Lipoprotein agarose gel electrophoresis and gradient gel electrophoresis were performed for the detection of LpX. The liver function tests, electrolytes, lipid profile and bile acids were also determined. Anti-tuberculous therapy was initiated and the liver functions improved with normalisation of the lipid profile