title: Anemia and growth failure among HIV-infected children in India: a retrospective analysis.
abstract: BACKGROUND
  Anemia and poor nutrition have been previously described as independent risk factors for death among HIV-infected children. We sought to describe nutritional status, anemia burden and HIV disease correlates among infected children in India.
  
  
  METHODS
  We analyzed retrospective data from 248 HIV-infected children aged 1-12 years attending three outpatient clinics in South India (2004-2006). Standard WHO definitions were used for anemia, HIV staging and growth parameters. Statistical analysis included chi square, t tests, univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  The overall prevalence of anemia (defined as hemoglobin < 11 gm/dL) was 66%, and 8% had severe anemia (Hb < 7 gm/dL). The proportion of underweight and stunted children in the population was 55% and 46% respectively. Independent risk factors of anemia by multivariate analysis included the pre-school age group (age younger than 6 years) (OR: 2.87; 95% CI: 1.45, 5.70; p < 0.01), rural residence (OR: 12.04; 95% CI: 5.64, 26.00; p < 0.01), advanced HIV disease stage (OR: 6.95; 95% CI: 3.06, 15.79; p < 0.01) and presence of stunting (Height-for-age Z Score < -2) (OR: 3.24; 95% CI: 1.65, 6.35; p < 0.01). Use of iron/multivitamin supplementation was protective against risk of anemia (OR: 0.44; 95% CI: 0.22, 0.90; p = 0.03). Pulmonary tuberculosis was an independent risk factor in multivariate analysis (OR: 3.36; 95% CI: 1.43, 7.89; p < 0.01) when correlated variables such as HIV disease stage and severe immunodeficiency, and nutritional supplement use were not included. Use of antiretroviral therapy (ART) was associated with a reduced risk of anemia (OR: 0.29; 95% CI: 0.16, 0.53; p < 0.01). No significant association was found between anemia and gender, cotrimoxazole, or ART type (zidovudine versus stavudine).
  
  
  CONCLUSIONS
  The high prevalence and strong interrelationship of anemia and poor nutrition among HIV-infected children in India, particularly those living in rural areas underscores the need for incorporating targeted nutritional interventions during national scale up of care, support and treatment among HIV-infected children.
authors.affiliation: Department of Pediatrics, St John's National Academy of Health Sciences, Bangalore, India. anitashet@gmail.com
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Nirmala
authors.initials: N
authors.lastname: Rajagopalan
authors.forename: Chitra
authors.initials: C
authors.lastname: Dinakar
authors.forename: Elango
authors.initials: E
authors.lastname: Ramesh
authors.forename: N M
authors.initials: NM
authors.lastname: Samuel
authors.forename: C K
authors.initials: CK
authors.lastname: Indumathi
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: Anura V
authors.initials: AV
authors.lastname: Kurpad
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000740:Anemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data; D004392:Dwarfism / Q000453:epidemiology; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D013851:Thinness / Q000453:epidemiology