Anemia and growth failure among HIV-infected children in India: a retrospective analysis

Shet, Anita; Mehta, Saurabh; Rajagopalan, Nirmala; Dinakar, Chitra; Ramesh, E.; Nm, Samuel; Indumathi, C K; Fawzi, Wafaie W.; Kurpad, Anura V

doi:10.1186/1471-2431-9-37

Cited by 74 publications

(110 citation statements)

References 37 publications

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“…Similarly, the percentage of wasting in our population was 12?9 % whereas data from south India reported 34 % (7) and 16 % (9) in the two studies. Although this difference may not be statistically significant because of the small sample size, the variation in results should be evaluated in terms of the general living conditions, socio-economic status, feeding practices, immunization status and prevalence of communicable infections in various states.…”

Section: Discussioncontrasting

confidence: 38%

Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children

Choudhary

Gomber

Narang

2012

Public Health Nutr.

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Objectives: To study the clinico-immunological, nutritional and growth characteristics of HIV-infected children and the impact of antiretroviral therapy (ART) on these parameters. Design: Retrospective study. Setting: Out-patient department of a paediatric ART centre, Delhi, India. Subjects: HIV-positive children registered at the paediatric ART centre of the hospital were enrolled (n 130). Anthropometric measurements were used to classify children into the type of malnutrition according to definitions of the WHO and US Centers for Disease Control and Prevention. Clinical and immunological status of the children was recorded as per WHO guidelines. First-line ART was started based on guidelines of the National AIDS Control Organization. Nutritional status and clinico-immunological characteristics were followed up annually in children receiving ART. Results: Of children #5 years of age (n 54), stunting was noted in 42?5 % contrary to wasting seen in only 12?9 %. In children .5 years of age (n 76), short stature (40?7 %) and underweight (39?4 %) were seen in almost equal proportions. Asymptomatic presentation was noted in 60?0 %. Following ART, a reduction in wasting was noted in 75?0 % of children #5 years of age, whereas only 44?4 % of underweight children .5 years of age showed an improvement after therapy. Stunting and short stature continued to persist in all in children (#5 years and .5 years, respectively). Clinico-immunologically, 67?5 % improved in clinical status and 62?5 % showed immunological improvement.

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Section: Discussioncontrasting

confidence: 38%

Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children

Choudhary

Gomber

Narang

2012

Public Health Nutr.

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“…However, low WAZ or low HAZ < -2 was significantly associated with anemia as in an Indian study. 4 In this study, 28.9% had abnormal ( ‡ 3 of 5) parameters but were not classified as IDA because few exhibited low serum ferritin levels ( Table 2). The most common abnormal parameters were MCV (84.3%), MCH (45.3%), and serum iron (38.3%).…”

Section: Discussionmentioning

confidence: 99%

“…13 IDA [3][4][5][6][7][8][9][10][11][12][13][14][15] was defined as anemia with (1) serum ferritin < 10 lg/ml if CRP was < 10 mg/liter or serum ferritin < 50 lg/ml if CRP was ‡ 10 mg/liter 16,17 and (2) having at least three of the following five parameters: (1) SI < 8.8 lmol/liter, (2) TIBC > 71.6 lmol/liter, (3) TS < 10%, (4) mean corpuscular volume (MCV) less than normal age-related values ( < 2 years = 78 fl, ‡ 2 years = 81 fl), or (5) mean corpuscular hemoglobin (MCH) less than normal age-related values ( < 2 years = 23 pg, 2-5 years = 24 pg, and ‡ 6 years = 25 pg). 14,15 Nonthalassemia was defined as having no common thalassemia mutations or deletions of a-and b-genes.…”

Section: Methodsmentioning

confidence: 99%

“…4 Although Thailand and Cambodia do not have formal recommendations for routine iron supplementation in HIV-infected children, the use of iron supplements in those with microcytic anemia is not uncommon. However, a Cochrane review reveals that routine iron prescription for anemic HIV-infected children is without proven benefit on morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Anemia and Underlying Iron Status in Naive Antiretroviral Therapy HIV-Infected Children with Moderate Immune Suppression

Kosalaraksa

Bunupuradah

Saphonn³

et al. 2012

AIDS Research and Human Retroviruses

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Anemia is common in HIV-infected children and iron deficiency is thought to be a common cause. This study investigates the prevalence of anemia, thalassemia, and underlying iron status in Thai and Cambodian children without advanced HIV disease to determine the necessity of routine iron supplementation. Antiretroviral (ARV)-naive HIV-infected Asian children aged 1-12 years, with CD4 15-24%, CDC A or B, and hemoglobin (Hb) ‡ 7.5 g/dl were eligible for the study. Iron studies, serum ferritin, Hb typing, and C-reactive protein were assessed. Anemia was defined as Hb < 11.0 g/dl in children < 5 years of age or < 11.5 g/dl in children 5-12 years. We enrolled 299 children; 57.9% were female and the mean (SD) age was 6.3 (2.9) years. The mean (SD) CD4% and HIV-RNA were 20% (4.6) and 4.6 (0.6) log 10 copies/ml, respectively. The mean (SD) Hb and serum ferritin were 11.2 (1.1) g/dl and 78.3 (76.4) lg/liter, respectively. The overall iron deficiency anemia (IDA) prevalence was 2.7%. One hundred and forty-eight (50%) children had anemia, mostly of a mild degree. Of these, 69 (46.6%) had the thalassemia trait, 62 (41.8%) had anemia of chronic disease (ACD), 9 (6.1%) had thalassemia diseases, 3 (2.0%) had iron deficiency anemia, and 5 (3.4%) had IDA and the thalassemia trait. The thalassemia trait was not associated with increased serum ferritin levels. Mild anemia is common in ARV-naïve Thai and Cambodian children without advanced HIV. However, IDA prevalence is low; with the majority of cases caused by ACD. A routine prescription of iron supplement in anemic HIV-infected children without laboratory confirmation of IDA should be discouraged, especially in regions with a high prevalence of thalassemia and low prevalence of IDA.

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“…However, its administration to the infected population is associated with complex complications. Several studies worldwide have shown in all compartments of the body diseases with antiretroviral therapy 4,5 . These are disturbances of lipid, protein, glucides profiles and even heart disease 6 .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2013

IJPSR

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Antiretroviral therapy for decades is the appropriate treatment for infected populations with human immunodeficiency virus (HIV). However, it is associated with complications that affect the organism infected. The combination of antiretroviral therapy and pregnancy degrades iron metabolism. This work aims to evaluate and characterize the impact of the interaction between antiretroviral therapy and different stages of pregnancy in women of Abidjan on all biological indicators of iron status. The conducted investigations were a prospective, cross-sectional, descriptive analytical and case-control study. They concerned 275 women of reproductive age in all trimesters of pregnancy and in consultation to integrated center for bioclinical research of Abidjan (ICBRA). These women were divided into two groups: 135 pregnant women infected with HIV without antiretroviral therapy as controls and 140 pregnant women infected with HIV receiving antiretroviral therapy. All biological indicators of iron metabolism were determined either by colorimetric or immunoturbidimetric assays through blood samples from each pregnant woman or by calculation. The Student t test, factor analysis of variance (ANOVA) with two factors and the G test or log likelihood ratio test with Statistica Statsoft Windows version 7.1 and software R.2.0.1 Windows version were used for the statistical analyzes data. The level of significance was defined for a p value < 0.05. The results of the study showed an extreme degradation in all evaluation of iron metabolism biological indicators assessment in all pregnant women. Analyzes of these biological parameters revealed that pregnant women with HIV and receiving treatment showed a significant alteration of their iron status (92 %) against 62.9 % in control pregnant women. However, latter have indicated a strong immunodepression towards the end of pregnancy with 40 % against 28 % among women on antiretroviral therapy. In addition, control subjects in early pregnancy reported a high rate of inflammatory anaemia associated with iron deficiency (30 % against 0 %) to critical stage (stage C) of HIV infection progression. The interaction between antiretroviral therapy and pregnancy disrupted iron metabolism in pregnant women infected with HIV. This deterioration is greater in infected pregnant women without antiretroviral therapy. The probable reasons for these changes in iron status of pregnant women infected with HIV in Abidjan are pregnancy and antiretroviral medication.

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Anemia and growth failure among HIV-infected children in India: a retrospective analysis

Abstract: Background: Anemia and poor nutrition have been previously described as independent risk factors for death among HIV-infected children. We sought to describe nutritional status, anemia burden and HIV disease correlates among infected children in India.

Cited by 74 publications

References 37 publications

Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children

Clinico-immunological profile and outcome of antiretroviral therapy in HIV-positive children

Prevalence of Anemia and Underlying Iron Status in Naive Antiretroviral Therapy HIV-Infected Children with Moderate Immune Suppression

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