Anemia and iron homeostasis in a cohort of HIV-infected patients in Indonesia

Contains fulltext : 97632.pdf (publisher's version ) (Open Access)BACKGROUND: Anemia is a common clinical finding in HIV-infected patients and iron deficiency or redistribution may contribute to the development of low hemoglobin levels. Iron overload is associated with a poor prognosis in HIV and Hepatitis C virus infections. Iron redistribution may be caused by inflammation but possibly also by hepatitis C co-infection. We examined the prevalence of anemia and its relation to mortality in a cohort of HIV patients in a setting where injecting drug use (IDU) is a main mode of HIV transmission, and measured serum ferritin and sTfR, in relation to anemia, inflammation, stage of HIV disease, ART and HCV infection. METHODS: Patient characteristics, ART history and iron parameters were recorded from adult HIV patients presenting between September 2007 and August 2009 in the referral hospital for West Java, Indonesia. Kaplan-Meier estimates and Cox's regression were used to assess factors affecting survival. Logistic regression was used to identity parameters associated with high ferritin concentrations. RESULTS: Anemia was found in 49.6% of 611 ART-naive patients, with mild (Hb 10.5 -12.99 g/dL for men; and 10.5-11.99 g/dL for women) anemia in 62.0%, and moderate to severe anemia (Hb < 10.5 g/dL) in 38.0%. Anemia remained an independent factor associated with death, also after adjustment for CD4 count and ART (p = 0.008). Seroprevalence of HCV did not differ in patients with (56.9%) or without anemia (59.6%). Serum ferritin concentrations were elevated, especially in patients with anemia (p = 0.07) and/or low CD4 counts (p < 0.001), and were not related to hsCRP or HCV infection. Soluble TfR concentrations were low and not related to Hb, CD4, hsCRP or ART. CONCLUSION: HIV-associated anemia is common among HIV-infected patients in Indonesia and strongly related to mortality. High ferritin with low sTfR levels suggest that iron redistribution and low erythropoietic activity, rather than iron deficiency, contribute to anemia. Serum ferritin and sTfR should be used cautiously to assess iron status in patients with advanced HIV infection

CASE REPORT Deep Vein Thrombosis in Acute Myelogenous Leukemia

ABSTRACT Thrombotic complications in acute leukemi

Pengaruh Service Quality, Perceived Value, Dan Customer Satisfaction Terhadap Customer Loyalty Pada Nasabah BCA Di Surabaya

Tujuan dari penelitian ini adalah untuk menguji dan menganalisis pengaruh service quality, perceived value, dan customer satisfaction terhadap loyalitas nasabah nasabah BCA di Surabaya. Penelitian ini menggunakan 250 sampel yang dikumpulkan dengan menyebarkan kuesioner menggunakan media Google Form. Selanjutnya tanggapan responden dianalisis menggunakan analisis Structural Equation Model (SEM) pada Partial Least Square (PLS). Hasil penelitian ini menunjukkan bahwa terdapat pengaruh yang signifikan antara kualitas pelayanan dengan loyalitas pelanggan. Selanjutnya penelitian ini menunjukkan bahwa kualitas pelayanan berpengaruh signifikan terhadap kepuasan pelanggan. Kemudian, penelitian ini menemukan bahwa kualitas layanan berpengaruh signifikan terhadap nilai yang dirasakan. Penelitian ini juga menemukan bahwa perceived value berpengaruh signifikan terhadap kepuasan pelanggan. Hasil akhir penelitian ini menunjukkan bahwa kepuasan pelanggan berpengaruh signifikan terhadap loyalitas pelanggan

Perbedaan Ekspresi Vascular Endothelial Growth Factor dan Ekspresi Tissue Factor Berdasarkan Respons Terapi Kemoradiasi Cisplatin pada Penderita Karsinoma Nasofaring Stadium lanjut

Vascular endothelial growth factor (VEGF) is a proangiogenic factor involved in the angiogenesis of NPC. Tissue factor (TF), the main initiator of blood coagulation, also signals protein that regulates angiogenesis. This study analyzed the differences between VEGF expression and TF expression in tumor tissue based on chemoradiation therapy response. Prospective cohort study was performed in NPC patients stage III, IVa and IVb according to the AJCC VII staging system. TF expression and VEGF expression were measured by immunohistochemistry, and chemoradiotherapy responses was evaluated by RECIST version 1.1 2009. Statistical analysis was performed using Fisher Exact test. From October 2012 to October 2013, 35 NPC patients were eligible for this study and 5 patients were excluded. In response group, there were 73.9% patients with VEGF expression ≥25%, 26.1% patients with VEGF expression <25%; 69.6% patients with TF expression ≥33%, 30.4% patients with TF expression <33% (p=1,000) and in no response group, there were 71,4% patients with VEGF expression ≥ 25%; 28.6% patients with VEGF expression <25%, 57.1% patients with TF expression ≥33%, 42.9% patients with TF expression <33% (p=0.657). In conclusion, there are differences between VEGF expression and TF expression based on the chemoradiation therapy response, but they are not significantly different

Correlation of serum hepcidin levels with hematology and iron parameters.

<p>Spearman correlation coefficient of serum hepcidin levels with (A) CD4 cell count, (B) serum ferritin levels, (C) hemoglobin levels and (D) mean corpuscular volume (MCV).</p

Hepcidin, iron and inflammatory parameters in HIV-infected patients at cohort enrollment.

<p>Data are based on 127 HIV-infected patients belonging to case group and the matched and unmatched control groups. Data depicted as median with interquartile range. TIBC, total iron binding capacity; sTfR, soluble transferrin receptor; CRP, C-reactive protein; ART, antiretroviral therapy; HCV, hepatitis C; ZDV, zidovudine; d4T, stavudine.</p><p>Hemoglobin and serum hepcidin levels were available for 127 patients; ferritin and sTfR for 107 patients and serum iron, TIBC, transferrin saturation and CRP in 38 patients, Anti HCV antibodies were available in 113 patients. Numbers of samples per groups are shown in superscript after the IQR.</p>a<p>p<0.01 between male and female group;</p>b<p>p<0.01 between anemia and non-anemia group;</p>c<p>p<0.05 between group with and without ART.</p