Children living with HIV have higher-than-normal prevalence
of anemia. The beneficial effect of therapeutic iron has been questioned in the
setting of high prevalence of infections. This study examines anemia prevalence
and effect of standard therapeutic iron on HIV disease progression among
children.
Perinatally-infected children aged 2–12 years were enrolled
at three sites in southern India, and were followed for 1 year with
clinical assessments, dietary recall and anthropometry. Laboratory parameters
included iron markers (ferritin, soluble transferrin receptor) and other
micronutrient levels (vitamin A, B 12 , folate). Iron was given to anemic children
based on WHO guidelines. Statistical analyses including frequency distributions,
chi square tests and multivariate logistic regression were performed using
Stata v13.0.
Among 240 children enrolled (mean age 7.7 years,
54.6 % males), median CD4 was 25 %, 19.2 % had advanced disease,
45.5 % had malnutrition, and 43.3 % were on antiretroviral treatment
(ART) at baseline. Anemia was prevalent in 47.1 % (113/240) children. Iron
deficiency was present in 65.5 %; vitamin A and vitamin B 12 deficiency in 26.6 % and 8.0 %
respectively; and anemia of inflammation in 58.4 %. Independent risk
factors for anemia were stunting, CD4 < 25 %, detectable viral load ≥400 copies/ml and vitamin A deficiency. Inadequate dietary
iron was prominent; 77.9 %
obtained less than two-thirds of recommended daily iron. Among clinically
anemic children who took iron, overall adherence to iron therapy was good, and
only minor self-limiting adverse events were reported. Median hemoglobin rose
from 10.4 g/dl to 10.9 mg/dl among those who took iron for
3 months, and peaked at 11.3 mg/dl with iron taken for up to
6 months. Iron was also associated with a greater fall in clinical
severity of HIV stage; however when adjusted for use of ART, was not associated
with improvement in growth, inflammatory and CD4 parameters.
Children living with HIV in India have a high prevalence of
anemia mediated by iron deficiency, vitamin A deficiency and chronic
inflammation. The use of therapeutic iron for durations up to 6 months
appears to be safe in this setting, and is associated with beneficial effects
on anemia, iron deficiency and HIV disease progression.
Below: Etiology of anemia in HIV. Proportions of micronutrient deficiency and inflammation contributing towards the etiology of anemia among HIV-infected children.
Full article at:
By:
1Department of Pediatrics, St. John’s
Medical College Hospital, Sarjapur Road, Bangalore 560034, India
2Department of Public Health Sciences,
Karolinska Institutet, Stockholm, Sweden
3Department of Clinical Research, National
Institute for Research in Tuberculosis, 1 Sathiyamoorthy Road, Chetput,
Chennai, India
4YRG Center for AIDS Research and Education,
Voluntary Health Services Taramani, Chennai, India
5Antiretroviral Treatment Center, Institute
of Child Health, Egmore, Chennai, India
6Indian Council of Medical Research (ICMR),
New Delhi, India
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