Elevated iron status strongly predicts mortality in West African adults with HIV infection.
OBJECTIVE
To comprehensively assess iron status and determine whether elevated iron status, like anemia, predicts mortality.


METHODS
We followed 1362 Gambian adults (53% female) in an HIV-seroprevalent clinic-based cohort over 11.5 years to ascertain all-cause mortality. Baseline iron status (iron, soluble transferrin receptor [sTfR], transferrin, ferritin, transferrin saturation, log [transferrin receptor: ferritin]), age, gender, ethnicity, hemoglobin, body mass index, HIV type, absolute CD4 count, malaria status, and [alpha]-(1)-antichymotrypsin were measured.


RESULTS
The mortality rate was 25.9/100 person-years. Elevated iron universally predicted greater mortality compared to normal iron status for all iron status indices, with the exception of sTfR in unadjusted models. In fully adjusted models, transferrin (elevated vs. normal, hazard ratio [HR]: 1.77; 95% confidence interval [CI]: 1.30 to 2.42; P < 0.001), ferritin (elevated vs. normal, HR: 1.40; 95% CI: 1.07 to 1.83; P = 0.014), and the combined iron status index (highly elevated vs. normal, HR: 2.20; 95% CI: 1.16 to 4.18; P = 0.016) remained significant predictors. As expected, hemoglobin (Hb) concentration and absolute CD4 counts were each inversely associated with mortality.


CONCLUSIONS
Elevated iron status predicts mortality in HIV infection, even after adjustment for immunosuppression and other confounders. This finding has implications in the clinical monitoring of disease progression and for iron-supplementation practices in areas of high HIV prevalence.
McDermid
Joann M
JM
Medical Research Council International Nutrition Group, Nutrition and Public Health Intervention Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, England, WC1E 7HT. joann.mcdermid@gmail.com
Jaye
Assan
A
Schim van der Loeff
Maarten F
MF
Todd
Jim
J
Bates
Chris
C
Austin
Steve
S
Jeffries
David
D
Awasana
Akum A
AA
Whittlex
Akum A
AA
Prentice
Andrew
A
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005714:Gambia / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood* / Q000401:mortality; D006801:Humans; D007501:Iron / Q000097:blood*; D008297:Male; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D007501:Iron