The relationship between hepcidin levels, CD4 counts, and complete blood count parameters with tuberculosis infection in patients with human immunodeficiency virus

Background: TB coinfection is one of the most important challenges in HIV/AIDS control. HIV patients have a 20-fold higher risk of TB infection, and by 2020, 209,000 deaths from HIV-TB coinfection have been reported. Coinfection control programs have been carried out with various approaches. However, until now, early diagnosis and treatment have not achieved satisfactory results. TB still appears at various stages of HIV. One study reported that in patients with HIV infection, the incidence of tuberculosis increases with the decline of CD4+ cells, which are a significant source of IFN-Ɣ. Decreased IFN-Ɣ in T cells due to hepcidin stimulus in affecting protection against Mtb. Hematologic parameters are clues that can predict a diagnosis and prognosis in infectious diseases, including in patients with tuberculosis and HIV. Hematologic abnormalities can be aggravated if TB and HIV infections occur simultaneously. Methods: This study used a cross-sectional analysis approach. The study subjects were determined using the consecutive method at Ngoerah Hospital. Hepcidin levels were measured using the ELISA method, CD4, and several whole blood parameters were obtained from the patient's medical records. Diagnosis of tuberculosis was based on examination of patient specimens using the Gene Xpert MTB/RIF RT-PCR molecular rapid test method Results: There were 60 subjects consisting of 49 (81.7%) males and 11 (18.3%) females. The mean age was 42.54±11.32 years. The cut-off point value of the hepsidin level was 439 ng/mL. Of the three main variables studied in the bivariate analysis using the Chi-Square test, a significant association between high hepcidin levels (p=0.018) and low CD4 levels (p=0.004) was found to be significantly associated with HIV-TB infection. While multiple whole blood variables (leucocytes, hemoglobin, and platelets) were not statistically significant (p=0.60; p=0.166; p=0.93). Multivariate analysis using logistic regression showed that high hepcidin levels (AOR 4.68; 95% CI: 1.34-16.28; p = 0.015) and low CD4 levels (AOR 6.18; 95% CI: 1.69-22.61; p = 0.006) were independently associated with HIV-TB coinfection, while other confounding factors were not significantly associated with HIV-TB coinfection Conclusion: High hepcidin levels and low CD4 levels are independently associated with HIV-TB coinfection. No statistically significant association was found between several complete blood count parameters and HIV-TB coinfection.