Iron Deficiency Anemia Is Highly Prevalent among Human Immunodeficiency Virus–Infected and Uninfected Infants in Uganda

Abstract

Although anemia is a common finding among human immunodeficiency (HIV)-infected infants in sub-Saharan Africa, the factors contributing to the pathogenesis of anemia have not been well characterized. We sought to characterize the relative contribution of iron deficiency and chronic disease to the anemia among infants. Hemoglobin, ferritin, erythropoietin, tumor necrosis factor-alpha (TNF-alpha), neopterin, CD4(+) lymphocyte count and plasma HIV load were measured in 165 HIV-infected and 39 uninfected 9-mo-old infants seen in an outpatient pediatric clinic in Kampala, Uganda. Among HIV-infected and uninfected infants, the prevalence of anemia (hemoglobin < 110 g/L) was 90.9 and 76.9%, respectively (P = 0.015), and the prevalence of iron deficiency anemia (hemoglobin < 110 g/L and ferritin < 12 microg/L) was 44.3 and 45.4%, respectively (P = 0.92). The relatively higher prevalence of anemia among HIV-infected infants was attributed to the anemia of chronic disease. Among infants with and without iron deficiency, the fitted regression line was log(10) plasma erythropoietin = 2.86 - 0.016.hemoglobin, and log(10) plasma erythropoietin = 4.11 - 0.028.hemoglobin, respectively, with a difference in the slope of the regression lines between log(10) erythropoietin and hemoglobin among infants with and without iron deficiency (P = 0.049). Infants in Uganda have an extremely high prevalence of anemia, and nearly half of the anemia is due to iron deficiency. The erythropoietin response to anemia appears to be upregulated among infants with iron deficiency.

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

“…31 Iron deficiency is highly prevalent (18.0-44.3%) in developing countries, 3,29 but not in this study. The high prevalences of IDA in other studies might be the result of the inclusion of children with poorer nutritional status and more severe clinical stage of HIV.…”

“…[27][28][29][30] In this study, we found that half of ARV-naive Asian children without advanced HIV had anemia. Most anemic children had a mild degree of anemia.…”

The prevalence and etiology of anemia among HIV-infected children in India

“…Anemia is common among children with HIV infection [14,47] and has been established as an independent marker for increased disease progression and death in both adults [23,45] and children [6,10]. An extensive national-level survey of the general Indian population revealed that 45% and 40% of children aged 6 months-3 years were stunted and underweight, respectively, and that 79% had anemia, of which iron deficiency was believed to be the leading cause [22].…”

Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi

“…Although the anemia of infection, a subset of the anemia of chronic disease (Means, 2000), may account for a large part of the anemia found in pulmonary tuberculosis, iron deficiency (Semba & Gray, 2001;Yip, 2001;Moyle, 2002), poor antioxidant status (Semba & Gray, 2001), and vitamin A deficiency (Moore, 1999;Semba & Bloem, 2002) may potentially contribute to the anemia. A blunted response of erythropoietin to anemia may occur in the anemia of infection (Means, 2000) and has been described in HIVinfected adults (Spivak et al, 1989;Camocho et al, 1992) and children (Totin et al, 2002). Interleukin-6 (IL-6), a proinflammatory cytokine, is a marker for the severity of infection (Wakefield et al, 1998) and has been shown to modulate the anemia of chronic disease (Feelders et al, 1998).…”