Person:

Perumal, Nandita

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.

Context: The association between linear growth faltering and child development outcomes is generally well-recognized; however, the relationship between metrics of acute undernutrition and development has received less attention. Objectives: We aimed to quantify the association between acute undernutrition in childhood with development outcomes in low- and middle-income countries (LMIC). Methods: We conducted a systematic literature review of observational studies that assessed the association between metrics of acute undernutrition, including body mass index-for-age z-score (BMIZ), mid-upper arm circumference (MUAC), weight-for-height/length z-score (WHZ/WLZ), wasting (WHZ/ WLZ <-2), and severe acute malnutrition (SAM) among children under 5 years of age with cognitive, motor, language, and socio-emotional development assessed to 19 years of age. We estimated the pooled correlation and standardized mean difference (SMD) for cross-sectional and longitudinal studies. Results: A total of 113 studies from 40 LMICs were identified. Metrics of acute undernutrition were associated with lower cognitive and motor development outcomes. In longitudinal studies that reported multivariable-adjusted estimates for the cognitive domain, SAM was associated with -1.06 SD lower scores (95% CI: -1.41, -0.72) as compared to non-SAM children. SAM was also associated with lower motor scores in longitudinal studies with unadjusted estimates (SMD: -0.42; 95% CI: -0.68, -0.15). In longitudinal studies with multivariable estimates, wasting was associated with lower motor scores (SMD: -0.30; 95% CI: -0.54, -0.06), but there was no association with language (SMD: -0.08; 95% CI: -0.24, 0.07) and prosocial development scores (SMD: -0.18; 95% CI: -0.38, 0.02). Conclusion: Metrics of acute undernutrition in childhood were consistently associated with lower development scores, and the magnitude appeared stronger for children with SAM or wasting.