Effect of dolutegravir on ferritin, iron, and C-reactive protein among people living with HIV and co-infections

Bridget Kamurai; Raylton P Chikwati; Donald Vhanda; Terrence Nyamayaro; Justen Manasa; Vinie Kouamou

doi:10.4102/sajhivmed.v25i1.1543

Effect of dolutegravir on ferritin, iron, and C-reactive protein among people living with HIV and co-infections

South Afr J HIV Med. 2024 Apr 30;25(1):1543. doi: 10.4102/sajhivmed.v25i1.1543. eCollection 2024.

Authors

Bridget Kamurai¹, Raylton P Chikwati^{2

3}, Donald Vhanda¹, Terrence Nyamayaro¹, Justen Manasa⁴, Vinie Kouamou⁴

Affiliations

¹ Department of Chemical Pathology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
² Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.

Abstract

Background: Dolutegravir-based antiretroviral therapy (ART) is currently recommended as the preferred first-line ART in many resource-limited settings. However, little is known about the clinical experience of dolutegravir within a context of prevalent co-infections.

Objectives: To assess virological outcomes, and iron, ferritin and C-reactive protein (CRP) levels among people living with HIV (PLWH) and co-infections after initiating or re-initiating dolutegravir-based ART.

Method: This prospective study was conducted between August 2022 and August 2023. Study participants were recruited from an HIV opportunistic infection clinic. Screening for co-infections (syphilis, hepatitis B virus, cytomegalovirus and herpes simplex virus) was performed at baseline, prior to ART initiation. Plasma HIV viral load (VL), CRP, ferritin and iron levels were measured at baseline and at the 6-month follow-up period.

Results: A total of 100 participants (51 women and 49 men) were enrolled in this study. The median age of the participants was 39 years. The prevalence of co-infections was 30%. Prior to ART initiation, participants with co-infections had higher VL, CRP and ferritin, and lower iron levels, compared to those without co-infections (P < 0.001). Following 6 months of ART, CRP and ferritin levels decreased while iron levels increased, regardless of co-infection status. However, CRP and ferritin remained significantly higher in those with co-infections despite similar and high rates of virologic suppression in both groups.

Conclusion: The presence of co-infections in PLWH is associated with higher VL and with chronic inflammation. Ferritin and CRP decreased on dolutegravir-based ART but remained higher in people with co-infections despite similar rates of virologic suppression.

Keywords: HIV; co-infections; dolutegravir; ferritin; iron; virological outcomes.

Grants and funding

Funding information This research was supported by the Fogarty International Center of the National Institutes of Health under Award number D43 TW011326.