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

Abstract

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.

Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

“…Median (IQR) age was 6.8 (3.7–9.6) years, CD4% was 9 (3–16)% and plasma HIV-RNA was 5.2 (4.7–5.6) log 10 copies/ml at HAART initiation in those with available testing. The most common regimens were stavudine/lamivudine/nevirapine (42%) and zidovudine/lamivudine/nevirapine (25%).…”

“…In addition, we did not have clinical information about other possible causes of anemia (e.g., history of hemoglobinopathy, iron deficiency anemia, concurrent bone marrow-suppressive medications), nor additional clinical management or outcomes data for the patients who developed severe anemia. Kosalaraksa et al reported that mild to moderate anemia was common (around 50%) among 299 ART-naïve Thai and Cambodian children without advanced HIV (16). However, prevalence of iron deficiency anemia was low (2.7%) and the majority of cases were caused by carriage of a thalassemia trait (47%) and anemia of chronic disease (42%) (16).…”

“…Kosalaraksa et al reported that mild to moderate anemia was common (around 50%) among 299 ART-naïve Thai and Cambodian children without advanced HIV (16). However, prevalence of iron deficiency anemia was low (2.7%) and the majority of cases were caused by carriage of a thalassemia trait (47%) and anemia of chronic disease (42%) (16). Therefore, iron supplementation in anemic HIV-infected Asian children without further assessment of red blood cell indices or iron levels may not necessarily be beneficial.…”

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

“…Mild anemia was found to be common in ARV-naïve Thai and Cambodian children without advanced HIV. However, iron deficiency prevalence was low, with the majority of cases caused by anemia of chronic disease (Kosalaraksa et al 2012).…”

Pathogenesis and clinical implications of HIV-related anemia in 2013

“…HIV ϩ children in Malawi were less likely to be iron deficient than HIV Ϫ children, 16 In a cohort of Thai children, the majority of HIV ϩ children with anemia were not iron deficient. 17 If HIV itself did not have pathogenic effects on the development of anemia, then the relative role of other risk factors such as nutritional deficiencies would likely be more extensive. In addition, HIV infection may also contribute to aberrant immune activation that exacerbates other etiologies of anemia.…”