Severe anemia is the primary outcome of childhood malaria in holoendemic malaria transmission regions such as western Kenya. HIV-1 and bacteremia are equally important diseases in Kenyan children. Anemia is also the hallmark trait of pediatric HIV-1 infection, and despite our previous reports of exacerbated anemia in malaria/HIV-1 co-infected childrena, we also observed significantly lower parasitemias without worsening anemia in malaria/bacteremia co-infected children. Abundant production of pro-inflammatory cytokines is known to adversely affect erythropoiesis and is common to malaria, HIV-1, and bacteremia. As such, we performed a comprehensive bead-based 25-plex Multiplex assay to identify cytokines patterns and profiles associated with negative and positive hematolgic outcomes in co-infected children. Children in Aims 1 and 2 infected with P. falciparum malaria (Pf[+], aged 3-36 mos., n=542) were stratified into three groups: HIV-1 negative (HIV-1[-]/Pf[+]); HIV-1 exposed (HIV-1[exp]/Pf[+]); and HIV-1 infected (HIV-1[+]/Pf[+]). In Aim 3, malaria and bacteremia co-infected children (n=192) were divided into three categories: malaria alone, Pf[+]; Gram negative bacteremia/malaria co-infected, G[-]/Pf[+]; and Gram positive bacteremia/malaria co-infected, G[+]/Pf[+]. Univariate, correlational, and hierarchical regression analyses were used to determine differences among the groups and to define predictors of worsening anemia. Aim 1 analyses revealed HIV-1[+]/Pf[+] children had significantly more malarial pigment-containing neutrophils (PCN), monocytosis, increased severe anemia (Hb<6.0g/dL), and ~10-fold greater mortality. Hierarchical multiple regression revealed that worsening anemia was associated with elevated pigment-containing monocytes, younger age, and increasing HIV-1 status (HIV-1[-]→HIV-1[exp]→HIV-1[+]). Aim 2, addressing the inflammatory milieu, demonstrated that exacerbated anemia was associated with inflammatory mediator (IM) dysregulation, but not parasitemic or erythropoietic indices. A principal component analysis revealed that IL-12 was the most influential variable on Hb levels in HIV-1[+]/Pf[+] children, while the IL-1β:IL-10 ratio was most influenced by PCN. In Aim 3, both bacteremia co-infected groups had lower parasitemia compared to the Pf[+] group. A multiple mediation model examining IMs responsible for decreased parasitemia in the bacteremia co-infected groups identified IL-4, IL-10, IL-12, and IFN-γ as the key molecules in decreasing parasitemia. Thus, malaria/HIV-1 co-infection is defined by significantly enhanced anemia that is associated with unique IM profiles known to exacerbate anemia, while enhanced immune activation in malaria/bacteremia co-infected children appears to promote reduced parasitemia without adversely affecting anemia outcomes. By defining the inflammatory milieu associated with severe anemia, therapies can be developed to mitigate detrimental immune responses, thereby lessening the pediatric public health burden in western Kenya.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07262010-170719 |
| Date | 28 September 2010 |
| Creators | Davenport, Gregory Charles |
| Contributors | Karen A. Norris, Robert W. Wadowsky, Todd A. Reinhart, Douglas J. Perkins, Tianyi Wang |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07262010-170719/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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