Iron Metabolism Markers in Patients with Tuberculosis Combined with HIV Infection

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Background. Changes of iron metabolism in patients with tuberculosis combined with HIV infection is an important task of phthisiology, since, on the one hand, iron deficiency can have a negative effect on the course of the tuberculous process. On the other hand, compensation for iron deficiency may be creating an iron overload situation, promoting replication of M. tuberculosis. Aims — to study in a comparative aspect, changes in iron metabolism markers in patients with tuberculosis combined with HIV infection and without it. Methods. The study included 284 tuberculosis patients who were divided into 2 groups. The first group included 141 patients with tuberculosis combined with HIV (TB/HIV group). The comparison group consisted of 143 tuberculosis patients without HIV (TB group). The assessment of the body’s iron supply was carried out in terms of the concentration of serum iron, transferrin (TF), and ferritin (FT). The study was conducted separately in men and women, since the indicators of iron metabolism in healthy men and women differ significantly. Results. It was found that in men with TB/HIV patients, the decrease in serum iron less than the lower limit of the norm took place in 47.6%, and in the TB group — in 27.3% of cases (p < 0.01). The concentration of TF in the blood serum in the group of TB/HIV patients in men decreased in 69.9%, and in the group of TB patients — in 31.2% of cases (p < 0.01). The level of FT in the TB/HIV group increased in 19.4%, and in the TB group — in 8.3% of cases (p < 0.05). In women, a decrease in iron levels in the group of TB/HIV patients was observed in 39.5%, and in the TB group — only in 2.2% of cases (p < 0.01), a decrease in the level of TF was observed in 55.2% and 24.3% (p < 0.01). A decrease in ferritin levels below 15 ng/ml was observed in 15.7% of women with TB/HIV and in 10.6% of TB patients. A negative relationship was found between iron content and CRP levels. Conclusion. The results of studied made it possible to conclude that in all cases the decrease in iron was caused not by a true deficiency of iron, but by its redistribution in the body. At the same time, a small number of women with tuberculosis combined with HIV infection and tuberculosis without HIV infection showed a significant decrease in ferritin levels, which indicated that they had a true iron deficiency.

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Rizvan Y.O. Abdullaev

Central Tuberculosis Research Institute

Author for correspondence.
ORCID iD: 0000-0002-9105-9264
SPIN-code: 4535-2302
Scopus Author ID: 15051804600
ResearcherId: R-1889-2018

MD, PhD, Professor

Russian Federation, Moscow

Oksana G. Komissarova

Central Tuberculosis Research Institute; Pirogov Russian National Research Medical University

ORCID iD: 0000-0003-4427-3804
SPIN-code: 6006-6732


Russian Federation, Moscow; Moscow

Olga R. Terentyeva

Central Tuberculosis Research Institute


PhD Student

Russian Federation, Moscow


  1. Долгов В.В., Луговская С.А., Морозова В.Т., и др. Лабораторная диагностика анемий. — М.: Тверь, 2009. — 148 с. [Dolgov VV, Lugovskaya SA, Morozova VT, et al. Laboratornaya diagnostika anemij. Moscow: Tver; 2009. 148 p. (In Russ.)]
  2. Лукина Е.А., Деженкова А.В. Метаболизм железа в норме и при патологии // Клиническая онкогематология. — 2015. — Т. 8. — № 4. — С. 355–361. [Lukina EA, Dezhenkova AV. Iron metabolism in normal and pathological conditions. Clinical oncohematology. 2015;8(4):355–361. (In Russ.)]
  3. Погорелов В.М., Козинец Г.И., Ковалева Л.Г. Лабораторно-клиническая диагностика анемии. — М.: Медицинское информационное агентство, 2004. — 173 с. [Pogorelov VM, Kozinec GI, Kovaleva LG. Laboratorno-klinicheskaya diagnostika anemii. Мoscow: Medicinskoe informacionnoe agentstvo; 2004. 173 p. (In Russ.)]
  4. Sritharan M. Iron homeostasis in Mycobacterium tuberculosis: Mechanistic insights into siderophore-mediated iron uptake. J Bacteriol. 2016;198(18):2399–2409. doi:
  5. Isanaka S, Aboud S, Mugusi F, et al. Iron status predicts treatment failure and mortality in tuberculosis patients: A prospective cohort study from Dar es Salaam, Tanzania. PLoS one. 2012;7(5):e38350. doi:
  6. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011–1023. doi:
  7. Инякова Н.В., Демихов В.Г., Журина О.Н. Анемия при туберкулезной инфекции // Вестник последипломного медицинского образования. — 2015. — № 3. — С. 74–81. [Inyakova NV, Demihov VG, Zhurina ON. Anemia of tuberculosis infection. Vestnik poslediplomnogo midicinskogo obrazovaniya. 2015;3:74–81. (In Russ.)]
  8. Каминская Г.О., Абдуллаев Р.Ю., Батурова Г.А., и др. Особенности обеспеченности организма железом у больных туберкулезом легких на фоне лечения // Туберкулез и болезни легких. — 2009. — T. 86. — № 7. — С. 46–55. [Kaminskaya GO, Abdullayev RYu, Baturova GA, et al. The specific features of iron intake in patients treated for pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2009;86(7):46–55. (In Russ.)].
  9. Dai Y, Shan W, Yang Q, et al. Biomarkers of iron metabolism facilitate clinical diagnosis in M. ycobacterium tuberculosis infection. Thorax. 2019;74(12):1161–1167. doi:
  10. Каминская Г.О., Абдуллаев Р.Ю., Комиссарова О.Г. Место растворимых рецепторов трансферрина в выявлении природы железодефицитных состояний у больных туберкулезом легких // Туберкулез и болезни легких. — 2013. — T. 90. — № 8. — С. 21–27. [Kaminskaya GO, Abdullayev RYu, Komissarova OG. Place of soluble transferrin receptors in identification of the nature of iron deficiency in patients with pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2013;90(8):21–27. (In Russ.)]
  11. Hella J, Cercamondi CI, Mhimbira F, et al. Anemia in tuberculosis cases and household controls from Tanzania: Contribution of disease, coinfections, and the role of hepcidin. PLoS One. 2018;13(4):e0195985. doi:
  12. Ratledge C. Iron, mycobacteria and tuberculosis. Tuberculosis (Edinb). 2004;84(1–2):110–130. doi:
  13. Gangaidzo IT, Moyo VM, Mvundura E, et al. Association of pulmonary tuberculosis with increased dietary iron. J Infect Dis. 2001;184(7):936–939. doi:
  14. Lee SW, Kang YA, Yoon YS, et al. The prevalence and evolution of anemia associated with tuberculosis. J Korean Med Sci. 2006; 21(6):1028–1032. doi:
  15. Kerkhoff AD, Meintjes G, Opie J, et al. Anaemia in patients with HIV-associated TB: relative contributions of anaemia of chronic disease and iron deficiency. Int J Tuber. Lung Dis. 2016;20(2):193–201. doi:
  16. Абдуллаев Р.Ю., Комиссарова О.Г., Герасимов Л.Н. Выраженность системного воспалительного ответа у больных туберкулезом, ассоциированным с ВИЧ-инфекцией // Туберкулез и болезни легких. — 2017. — Т. 95. — № 6. — С. 36–40. [Аbdullаev RY, Komissаrovа OG, Gerаsimov LN. The intensity of systemic inflammation response in those suffering from HIV-associated tuberculosis. Tuberculosis and Lung Diseases. 2017;95(6):36–40. (In Russ.)] doi:
  17. Johnsona EE, Wessling-Resnickb M. Iron Metabolism and the innate immune response to infection. Microbes Infect. 2012;14(3):207–216. doi:
  18. Ekiz C, Agaoglu L, Karakas Z, et al. The effect of iron deficiency anemia on the function of the immune system. Hematol J. 2005;5(7):579–583. doi:
  19. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization; 2020. 72 p. Licence: CC BY-NC-SA 3.0 IGO.
  20. Taha DA, Thanoon Imad A-J. Antioxidant Status, C-Reactive Protein and Iron Status in Patients with Pulmonary Tuberculosis. Sultan Qaboos Univ Med J. 2010;10(3):361–369.
  21. Kassu A, Yabutani T, Mahmud ZH, et al. Alteration in serum levels of trace elements in tuberculosis and HIV infections. Eur J Clin Nutr. 2006; 60(5):580–586. doi:
  22. Minchella PA, Donkor S, Owolabi O, et al. Complex anemia in tuberculosis: the need to consider causes and timing when designing interventions. Clin Infect Dis. 2015;60(5):764–772. doi:
  23. O’Brien ME, Kupka R, Msamanga GI, et al. Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania. J Acquir Immune Defic Syndr. 2005;40(2):219–225. doi:
  24. van Lettow M, West CE, van der Meer JWM, et al. Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi. Eur J Clin Nutr. 2005;59(4):526–532. doi:
  25. Andrew KD, Wood R, Vogt M, et al. Predictive value of anaemia for tuberculosis in HIV-infected patients in sub-Saharan Africa: an indication for routine microbiological investigation using new rapid assays. J Acquir Immune Defic Syndr. 2014;66(1):33–40. doi:
  26. Bregman DB, Morris D, Koch TA, et al. Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia. Am J Hematol. 2013;88(2):97–101. doi:

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