Iron Deficiency is Prevalent among HIV-Infected Kenyan Adults and is Better Measured by Soluble Transferrin Receptor than Ferritin

Frosch, Anne E.; Ayodo, George; Odhiambo, Eliud O.; Ireland, Kathleen F.; Vulule, John; Cusick, Sarah E.

doi:10.4269/ajtmh.18-0208

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…The best, though still suboptimal, conventional peripheral blood marker for iron deficiency, was MCV. Microcytosis is commonly used as a screening test for iron deficiency [34,49,50]; however, MCV has not been found to be an accurate predictor of BM-ID [10,11,48]. Our findings confirm this as MCV did not have a high sensitivity or specificity and the AUC ROC was of low diagnostic value.…”

Section: Discussionsupporting

confidence: 72%

“…Although sTfR had a poor AUC ROC it did have a better sensitivity than hepcidin and thus may be used to screen for iron deficiency. Overall sTfR levels in our population were low compared to other studies [48]. This may reflect the high prevalence of inflammation and end-stage HIV disease in our population, which are both associated with low sTfR levels [38].…”

Section: Discussioncontrasting

confidence: 62%

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A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

et al. 2020

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Introduction Iron deficiency is a treatable cause of severe anaemia in low-and-middle-income-countries (LMIC). Diagnosing it remains challenging as peripheral blood markers poorly reflect bonemarrow iron deficiency (BM-ID), especially in the context of HIV-infection. Methods Severely anaemic (haemoglobin �70g/l) HIV-infected adults were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. BM-ID was evaluated. Accuracy of blood markers (including hepcidin, mean corpuscular volume, mean cellular haemoglobin concentration, serum iron, serum ferritin, soluble transferrin receptor (sTfR), sTfR index, sTfR-ratio) to detect BM-ID was evaluated by ROC area under the curve (AUC ROC). Results Seventy-three patients were enrolled and 35 (48.0%) had BM-ID. Although hepcidin and MCV performed best (AUC ROC of 0.593 and 0.545 respectively) all markers performed poorly in identifying BM-ID (ROC<0.6). The AUC ROC of hepcidin in males was 0.767 (sensitivity 80%, specificity 78%) and in women 0.490 (sensitivity 60%, specificity 61%). Conclusion BM-ID deficiency was common in severely anaemic HIV-infected patients. It is an important and potential treatable contributor to severe anaemia but lack of definitive biomarkers

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Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 62%

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

et al. 2020

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“…In HIV infection, ferritin, a marker of iron deficiency, may be altered by inflammation (39,40). This has been confirmed by the study of Frosch et al (39), who found elevated levels of ferritin in HIV-infected individuals without correlation with iron deficiency anemia. In this latter investigation, the iron biomarker soluble transferrin receptor (sTfR) was the best predictor of anemia in the HIV-infected participants, and (sTfR) was also associated with a 6-fold increase in the odds of anemia.…”

Section: Malnutrition and The Immune System In Hiv-infected Infantsmentioning

confidence: 82%

“…Furthermore, coexistence commonly occurs between iron deficiency and HIV infection (38). In HIV infection, ferritin, a marker of iron deficiency, may be altered by inflammation (39,40). This has been confirmed by the study of Frosch et al (39), who found elevated levels of ferritin in HIV-infected individuals without correlation with iron deficiency anemia.…”

Section: Malnutrition and The Immune System In Hiv-infected Infantsmentioning

confidence: 88%

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

Fabusoro

Mejía

2021

Advances in Nutrition

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HIV infection and undernutrition remain significant public health concerns for infants and children. In infants and children under these conditions, undernutrition is one of the leading causes of death. Proper management of nutrition and related nutrition complications in these groups with increased nutrition needs are prominent challenges, particularly in HIV-prevalent poor-resource environments. Several studies support the complexity of the relation between HIV infection, nutrition, and the immune system. These elements interact and create a vicious circle of poor health outcomes. Recent studies on the use of probiotics as a novel approach to manage microbiome imbalance and gut-mucosal impairment in HIV infection are gaining attention. This new strategy could help to manage dysbiosis and gut-mucosal impairment by reducing immune activation, thereby potentially forestalling unwanted health outcomes in children with HIV. However, existing trials on HIV-infected children are still insufficient. There are also conflicting reports on the dosage and effectiveness of single or multiple micronutrient supplementation in the survival of HIV-infected children with severe acute malnutrition. The WHO has published guidelines that include time of initiation of antiretroviral therapy for HIV-pregnant mothers and their HIV-exposed or HIV-infected children, micronutrient supplementation, dietary formulations, prevention, and management of HIV therapy. However, such guidelines need to be reviewed owing to recent advances in the field of nutrition. There is a need for new intervention studies, practical strategies, and evidence-based guidelines to reduce the disease burden, improve adherence to treatment regimen, and enhance the nutrition, health, and well-being of HIV-infected infants and children. This review provides up-to-date scientific information on current knowledge and existing challenges for nutrition therapy in HIV-infected infants and children. Moreover, it presents new research findings that could be incorporated into current guidelines.

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“…CRP and ferritin concentrations, both acute phase markers, were higher for the ART-Y group at baseline than for the other groups, but not at 12 and 24 months. This likely represents improvements in inflammation associated with initially untreated advanced HIV infection, (48) which improved with immune restoration, though other mechanisms are possible. (49) The strengths of the study were its longitudinal design, that no participant was exposed to ART at baseline, the inclusion of an age-appropriate HIV-negative reference group and an ARTunexposed group, as well as the fact that the majority of the ART-Y group received standard South African first-line treatment, thereby minimizing the confounding effects of various ART combinations.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density, Body Composition, and Mineral Homeostasis Over 24 Months in Urban South African Women With HIV Exposed to Antiretroviral Therapy

et al. 2020

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Human immunodeficiency virus-(HIV-) infection and antiretroviral therapy (ART) exposure are associated with bone loss. African data are limited despite the region's HIV burden. Of 247 ART-naïve, premenopausal, urban, black African women aged 33.9 AE 6.6 years from Soweto, South Africa, measured at baseline, 110 underwent anthropometry, DXA, and blood and urine collections at 12 and 24 months; 39 were HIV-negative (Nref), 28 were people with HIV (PWH) not ART-exposed for the duration of the study (ART-N), and 43 were PWH who were ART-exposed within the first 12 months (ART-Y). At baseline, the ART-Y group had lower BMI and fat mass than the Nref group. Within 12 months of ART initiation, areal bone mineral density (aBMD) had decreased at the lumbar spine and at the whole body less head, despite increased weight, and hip aBMD had not increased in line with the Nref group. There was no evidence of further bone changes between 12 and 24 months. By 24 months, the ART-Y women had gained weight and fat mass, but remained lighter with less fat than the Nref women. ART initiation normalized the low serum albumin of the ART-Y group at baseline, but was associated with elevated bone turnover markers at 12 and 24 months. Vitamin D status and renal phosphate handling were normal. ART-N had similar aBMD and other characteristics to the Nref group throughout, except unlike the Nref group, weight and fat mass did not increase and serum albumin decreased. This study in African women of childbearing age demonstrated that the bone loss that had occurred in these PWH after ART initiation did not continue after 12 months and that bone loss did not occur in ARTunexposed PWH over 2 years. At 24 months, despite gains in weight and fat mass, ART-exposed women remained lighter, with lower aBMD, fat mass, and higher bone turnover than women without HIV. More studies are required to establish if the bone loss and fat gain reverse, stabilize, or continue with further ART exposure, particularly during and after menopause.

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Iron Deficiency is Prevalent among HIV-Infected Kenyan Adults and is Better Measured by Soluble Transferrin Receptor than Ferritin

Cited by 15 publications

References 20 publications

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

Bone Mineral Density, Body Composition, and Mineral Homeostasis Over 24 Months in Urban South African Women With HIV Exposed to Antiretroviral Therapy

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