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Circulating antioxidants and lipid peroxidation products in untreated tuberculosis patients in Ethiopia^1,2,3

¹ From the Center for International Health (TM and BL) and the Department of Clinical Biochemistry (RKB), University of Bergen, Bergen, Norway; Yirga Alem Hospital, Yirga Alem, Ethiopia (TM and BL); the Department of Medicine, Rogaland Central Hospital, Stavanger, Norway (TM); and the Section of Clinical Immunology and Infectious Disease and the Research Institute for Internal Medicine, University of Oslo, The National Hospital, Rikshospital, Oslo (PA).

Background: Knowledge of the antioxidant profile and its relation to lipid peroxidation in tuberculosis patients with or without accompanying HIV infection is scarce, particularly in developing countries.

Objective: The objective was to further investigate the interaction between HIV, tuberculosis, and antioxidants and their relations with markers of oxidative stress in a large population of Ethiopians.

Design: In a cross-sectional study, we evaluated antioxidants and markers of oxidative stress in Ethiopian tuberculosis patients with (n = 25) and without (n = 100) HIV infection and in Ethiopian (n = 45) and Norwegian (n = 25) healthy control subjects.

Results: Concentrations of the antioxidant vitamins C and E and of vitamin A were significantly lower in tuberculosis patients than in healthy Ethiopians. Tuberculosis patients also had significantly lower thiol concentrations, particularly of the reduced forms. Tuberculosis patients, particularly those who were co-infected with HIV, had higher malondialdehyde concentrations than did control subjects. High malondialdehyde concentrations were associated with clinical severity as measured by the Karnofsky Performance Status Index and anthropometric scores. Ethiopian control subjects had lower concentrations of vitamin E and higher concentrations of malondialdehyde than did Norwegian control subjects.

Conclusions: Our findings further support a link between oxidative stress, tuberculosis, and HIV infection. However, whether antioxidant supplementation will improve tuberculosis outcome or is of importance for its prevention should be further examined in future prospective studies.

Key Words: Tuberculosis • HIV • malnutrition • glutathione • antioxidants • oxidative stress

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