Estimation Of Serum Erythropoietin Levels in Anaemic HIV Infected Patients in Lagos, Nigeria

Erythropoietin(EPO) response to anaemia has been reported to be suboptimal in HIV infected anaemic patients.

To assess the relationship between EPO levels and degree of anaemia, CD4+ cell count and viral load of HIV infected treatment naive subjects and if there is any association with inflammatory cytokines.

A total of 120 subjects aged 18-66 years, comprises (1) HIV infected treatment naive subjects who had anaemia with Hb level <10g/dL. Control subjects were: (2) HIV infected non-anaemic, (3) non-HIV infected anaemic and (4) non-HIV infected non-anaemic individuals. Full blood count using automated counter; CD4+ cell count by semi-automated flow cytometer; and viral load were estimated. Serum erythropoietin levels, serum ferritin levels, CRP levels, TNF-α levels and IL-6 levels were estimated. Appropriateness of EPO response was determined by calculating EPO response ratio.

Majority (72%) of the HIV infected anaemic patients had a normocytic hypochromic type of anaemia. A weak positive correlation between EPO levels and CD4+ cell count (r=0.075, p=0.572) was obtained. A significant negative correlation between EPO levels and haemoglobin levels (r=-0.268, p=0.003). Twenty-seven (71.05%) of the 38 HIV infected anaemic subjects had EPO response ratio less than 0.8. Serum ferritin level was significantly higher in HIV infected anaemic subjects compared to the controls (p=0.000). Serum interleukin-6 level was significantly higher in HIV infected anaemic subjects compared to HIV infected non-anaemic subjects (p=0.003). Serum C-reactive protein level was significantly higher in HIV infected anaemic subjects compared to non-HIV infected non-anaemic (p=0.004) and non-HIV infected anaemic subjects and(0.001). Serum tumour necrosis factor-α level was significantly higher in HIV infected anaemic subjects compared to other arms of the study population (p=0.000).

The present study revealed that HIV infected anaemic subjects had reduced serum EPO levels. However, serum inflammatory cytokines levels were raised in the same subjects.

No relevant conflicts of interest to declare.