Person:

Andersen, Christopher

Abstract Background Anaemia is common among HIV-infected children and iron supplementation is prescribed routinely for the prevention and management of anaemia among children. Limited evidence suggests iron supplementation may have adverse effects among HIV-infected populations. We aimed to estimate the effect of iron supplement use on mortality, disease progression and haematological outcomes among HIV-infected children in Dar es Salaam, Tanzania.

Methods A prospective cohort study was conducted among HIV-infected children (aged 0–14 years) receiving antiretroviral treatment or supportive care between October 2004 and September 2014. Clinical data were recorded on morbidity and vital status, haematological status and prescriptions at each clinical visit. Cox proportional hazards models adjusted for time-varying covariates were used to estimate the association of time-varying iron supplementation on the hazard rate of mortality, HIV disease stage progression, tuberculosis incidence and anaemia and microcytosis persistence.

Results In all, 4229 children were observed during 149 260 clinic visits for a mean follow-up of 2.9 years. After adjustment for time-varying clinical covariates, time-varying iron supplementation was associated with a 2.87 times higher hazard rate of mortality (95% CI: 1.70, 4.87) and a 1.48 times higher hazard rate of HIV disease stage progression (95% CI: 1.10, 1.98). Iron supplementation was also associated with a lower rate of anaemia persistence (HR = 0.47; 95% CI: 0.37, 0.61). No differences in the association between iron supplementation and clinical outcomes were observed by antiretroviral therapy or anaemia status.

Conclusions Iron supplementation may increase the risk of HIV disease stage progression and mortality among HIV-infected children, while reducing the risk of anaemia.

Background: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. Objective: To estimate the proportion of anemia cases attributable to nutritional, infectious disease, and other risk factors among women, men, and children in six regions of Ethiopia. Methods: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15–49 years), 1,044 adult men (15–49 years), and 1,528 children (6–59 months). Participants provided venous blood samples for assessment of hemoglobin concentration, ferritin, folate, vitamin B12, C-reactive protein, and malaria infection. Stool samples were collected to ascertain helminth infection status. Sociodemographic questionnaires and a 24-hour diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages (pPAR%) were estimated using generalized linear models. Results: Anemia prevalence was 17% (95% CI: 13%, 21%) among women, 8% (6%, 12%) among men, and 22% (19%, 26%) among children. Low serum ferritin contributed to 11% (-1%, 23%) of anemia cases among women, 9% (0%, 17%) among men, and 21% (4%, 34%) among children. The proportion of anemia attributable to low serum folate was estimated at 25% (5%, 41%) among women and 29% (11%, 43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than one in ten anemia cases. Conclusions: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.