title: A prospective, cross-sectional study of anaemia and peripheral iron status in antiretroviral naïve, HIV-1 infected children in Cape Town, South Africa.
abstract: BACKGROUND
  Anaemia is a common manifestation of paediatric HIV infection. Although there are many causes, anaemia of chronic diseases is the most frequent type. In poor countries iron deficiency is widespread. It is probable that many HIV-infected children in these countries are also iron deficient. This study describes the relationship between paediatric HIV infection and anaemia, and documents the peripheral iron status of antiretroviral naive, HIV-infected children.
  
  
  METHODS
  Sixty children were evaluated prospectively. Investigations included CD4+ count, haemoglobin concentration (Hb), red blood cell (RBC) morphology, and iron studies.
  
  
  RESULTS
  Anaemia was present in 73% of children. Compared to mild HIV infection, median Hb was lower in children with moderate clinical infection (104 g/L v 112 g/L, p = 0.04) and severe clinical infection (96 g/L v 112 g/L, p = 0.006), and more children with severe infection were anaemic (92% v 58%, 0.04). There was a significant relationship between immunological status and Hb. 68% had abnormal RBC morphology. Significantly more children with moderate and severe disease, and severe immunosuppression had abnormal RBC morphology. 52% were iron-depleted, 20% had iron-deficient erythropoiesis and 18% iron deficiency anaemia (IDA). 16% (7/44) of anaemic children had microcytosis and hypochromia. Median soluble transferrin receptor concentration was significantly higher in those with microcytic hypochromic anaemia (42.0 nmol/L v 30.0 nmol/L, p = 0.008).
  
  
  CONCLUSIONS
  Both the proportion of anaemic children and the median Hb were associated with disease status. Iron depletion and IDA are major problems in HIV-infected children in South Africa.
authors.affiliation: School of Child and Adolescent Health, University of Cape Town and Red Cross Children's Hospital, Private Bag, Rondebosch, 7700, South Africa. beley@ich.uct.ac.za
authors.forename: Brian S
authors.initials: BS
authors.lastname: Eley
authors.forename: Alan A
authors.initials: AA
authors.lastname: Sive
authors.forename: Margaret
authors.initials: M
authors.lastname: Shuttleworth
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Hussey
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000473:pathology; D000740:Anemia / Q000097:blood* / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D005293:Ferritins; D007501:Iron