Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections

Abstract

Objective Anaemia is common during pregnancy, and prenatal Fe supplementation is the standard of care. However, the persistence of anaemia despite Fe supplementation, particularly in HIV infection, suggests that its aetiology may be more complex and warrants further investigation. The present study was conducted to examine predictors of incident haematological outcomes in HIV-infected pregnant women in Tanzania. Design Prospective cohort study. Cox proportional hazards and binomial regression models were used to identify predictors of incident haematological outcomes: anaemia (Hb < 110 g/l), severe anaemia (Hb < 85 g/l) and hypochromic microcytosis, during the follow-up period. Setting Antenatal clinics in Dar es Salaam, Tanzania. Subjects Participants were 904 HIV-infected pregnant women enrolled in a randomized trial of vitamins (1995–1997). Results Malaria, pathogenic protozoan and hookworm infections at baseline were associated with a two-fold increase in the risk of anaemia and hypochromic microcytosis during follow-up. Higher baseline erythrocyte sedimentation rate and CD8 T-cell concentrations, and lower Hb concentrations and CD4 T-cell counts, were independent predictors of incident anaemia and Fe deficiency. Low baseline vitamin D (<32 ng/ml) concentrations predicted a 1·4 and 2·3 times greater risk of severe anaemia and hypochromic microcytosis, respectively, during the follow-up period. Conclusions Parasitic infections, vitamin D insufficiency, low CD4 T-cell count and high erythrocyte sedimentation rate were the main predictors of anaemia and Fe deficiency in pregnancy and the postpartum period in this population. A comprehensive approach to prevent and manage anaemia, including micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings – particularly during the pre- and postpartum periods.

Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

“…12,13 In a study in Tanzania, low CD4 T-cell count, high erythrocyte sedimentation rate, and vitamin D insufficiency were noted as main predictors of anemia in HIV-infected pregnant and postpartum women. 14 Patients who were being treated for TB were at higher risk for anemia. Previous studies have shown that anemia, along with other factors such as HIV disease progression and CD4 ALT = alanine aminotransferase; ART = antiretroviral treatment; AZT = zidovudine; BMI = body mass index; CI = confidence interval; D4T = stavudine; EFV = efavirenz; TDF = tenofovir; FTC = emtricitabine; Hgb = hemoglobin; HIV = human immunodeficiency virus; IDA = iron deficiency anemia; MCV = mean corpuscular volume; NVP = nevirapine; TB = tuberculosis; 3TC = lamivudine; WHO = World Health Organization.…”

Hemoglobin Concentration and Parasitemia on Hospital Admission Predict Risk of Multiple Organ Dysfunction Syndrome among Adults with Malaria

“…Hemoglobin was categorized as 11 g/dL (normal), 8.5 and 11 g/dL (anemic), and 8.5 g/dL (severely anemic). [16][17][18] In bivariate analyses, we compared the distribution of the continuous SOFA score outcome between categories of each predictor using the Kruskall Wallis test. Adjusted mean differences and 95% confidence intervals (CIs) for the continuous SOFA score outcome were estimated from multivariable linear regression using empirical variances.…”

Letter to the Editor

“…The authors reported that 'micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings' (1) . I agree completely with this useful suggestion.…”

“…In addition to Hb concentrations, serum ferritin and transferrin receptor, and at least one acute-phase protein, such as C-reactive protein or a-1 acid glycoprotein, would further improve Fe assessment in the context of inflammation and infection. With an average of nine Hb measurements per person (over 9000) collected prospectively at the time of the study, it was not possible to conduct a more detailed analysis of Fe status on all samples collected prospectively in the ancillary analysis (1) . However, we previously published a detailed analysis of Fe status in the same cohort to examine the proportion of anaemia attributable to Fe deficiency among 584 HIV-infected women, including Hb, serum ferritin, serum transferrin receptor and C-reactive protein concentrations (7) .…”