Conditions Associated with Hyperferritinemia in HIV Positive Patients.
Authors: Kodali Srinivas , Kafeel Muhammad , Naik Seema , Rathnasabapathy Chenthilmurugan , He Zili , Kalavar Madhumati , Steir William 
Published: April 2020

Abstract
HIV is associated with progressive iron deposition in the bone marrow, liver and other organs. One of the pathways of developing increased iron stores may be due to sequestration of iron in the macrophages because of chronic inflammation. Increased iron stores might favor HIV progression by impairing key mediators in the host response. The aim of this study is to look at the frequency of other common co morbid conditions that exist in HIV positive patients that cause hyperferritinemia. We retrospectively reviewed the available charts of patients with HIV admitted to the Brookdale Hospital and Medical center over a period of 1 year, who had ferritin levels measured during the hospital admission. The lab values including the ferritin level, admitting diagnosis and other coexisting medical conditions were obtained from the medical charts. The results are summarized in table 1. A total of 56 HIV positive patient’s (33 females and 23 males) charts were reviewed and of those, 66% of patients had ferritin levels greater than 350ng/ml and 32% of them had ferritin level &gt;1000ng/ml. The mean ferritin level was 1247ng/ml in males and 582ng/ml in females. Males had ferritin levels &gt;1000ng/ml in 52% of them, compared to 18% in females. The mean ferritin level was 1203ng/ml in patients with CD4 &lt;100 and 467ng/ml in patients with CD4 counts &gt;100. Forty seven percent of the patients with CD4 &lt;100 had ferritin levels &gt;1000ng/ml. The mean ferritin level in patients with renal failure was 1166ng/ml. Forty six percent of the patients with renal failure (both acute and chronic) had ferritin levels &gt;1000 ng/ml. Patients with coexisting Hepatitis C infection had a mean ferritin level of 976ng/ml and ferritin levels were &gt;1000 ng/ml in 45.4% of the patients .The mean ferritin level was 946ng/ml in patients with liver failure and 41.6% of them had ferritin levels greater than 1000ng/ml. Thirty seven percent of the patients with hemoglobin less than 11 gm/dl had high ferritin compared to 16.6% of patients with hemoglobin level greater than 11 gm/dl. Nine patients died and six of them had ferritin level &gt;1000ng/ml. Twenty six percent of the total 56 patients had transferrin saturation less than 15%. Among the patients with high ferritin (greater than 1000ng/ml) 33.3% had transferrin saturation less than 15%. Transferrin saturation was greater than 50% in 11% patients among the patients with high ferritin levels. As per our study results in HIV positive patients, male sex, renal failure, CD4 count &lt;100, Hepatitis C infection, liver failure and low hemoglobin are more frequently associated with hyperferritinemia. Ferritin levels do not correlate with the transferrin saturation and may not be helpful in diagnosing iron deficiency in HIV positive patients but may be a marker for disease severity. Hepcidin may play a role in the regulation of iron metabolism in HIV positive patient’s needs further studies.
Table 1 Factors Percentage of Patients with ferritin &gt;1000 ng/ml Mean ferritin level(ng/ml) Males (23) 52.17 % 1247 ± 903 Females(33) 18 % 582 ± 537 CD4&lt;100 (22) 47 % 1203 ± 963 Renal Failure(15) 46.6 % 1166 ± 690 Hepatitis C (11) 45.4 % 976 ± 853 Liver failure (10) 41.6 % 946 ±1021