Prevalence of anemia and underlying iron status in naive antiretroviral therapy HIV-infected children with moderate immune suppression.
Anemia is common in HIV-infected children and iron deficiency is thought to be a common cause. This study investigates the prevalence of anemia, thalassemia, and underlying iron status in Thai and Cambodian children without advanced HIV disease to determine the necessity of routine iron supplementation. Antiretroviral (ARV)-naive HIV-infected Asian children aged 1-12 years, with CD4 15-24%, CDC A or B, and hemoglobin (Hb) ≥7.5 g/dl were eligible for the study. Iron studies, serum ferritin, Hb typing, and C-reactive protein were assessed. Anemia was defined as Hb <11.0 g/dl in children <5 years of age or <11.5 g/dl in children 5-12 years. We enrolled 299 children; 57.9% were female and the mean (SD) age was 6.3 (2.9) years. The mean (SD) CD4% and HIV-RNA were 20% (4.6) and 4.6 (0.6) log(10) copies/ml, respectively. The mean (SD) Hb and serum ferritin were 11.2 (1.1) g/dl and 78.3 (76.4) μg/liter, respectively. The overall iron deficiency anemia (IDA) prevalence was 2.7%. One hundred and forty-eight (50%) children had anemia, mostly of a mild degree. Of these, 69 (46.6%) had the thalassemia trait, 62 (41.8%) had anemia of chronic disease (ACD), 9 (6.1%) had thalassemia diseases, 3 (2.0%) had iron deficiency anemia, and 5 (3.4%) had IDA and the thalassemia trait. The thalassemia trait was not associated with increased serum ferritin levels. Mild anemia is common in ARV-naïve Thai and Cambodian children without advanced HIV. However, IDA prevalence is low; with the majority of cases caused by ACD. A routine prescription of iron supplement in anemic HIV-infected children without laboratory confirmation of IDA should be discouraged, especially in regions with a high prevalence of thalassemia and low prevalence of IDA.
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. pkosalaraksa@yahoo.com
Pope
P
Kosalaraksa
Torsak
T
Bunupuradah
Saphonn
S
Vonthanak
Surapon
S
Wiangnon
Rawiwan
R
Hansudewechakul
Ung
U
Vibol
Suparat
S
Kanjanavanit
Chaiwat
C
Ngampiyaskul
Jurai
J
Wongsawat
Wicharn
W
Luesomboon
Pagakrong
P
Lumbiganon
Bunruan
B
Sopa
Tanakorn
T
Apornpong
Theshinee
T
Chuenyam
David A
DA
Cooper
Kiat
K
Ruxrungtham
Jintanat
J
Ananworanich
Thanyawee
T
Puthanakit
D000293:Adolescent; D000740:Anemia / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000032:analysis; D018791:CD4 Lymphocyte Count; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005293:Ferritins / Q000097:blood; D015658:HIV Infections / Q000150:complications*; D006454:Hemoglobins / Q000032:analysis / Q000145:classification; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood*; D008297:Male; D015995:Prevalence; D013785:Thailand / Q000453:epidemiology
D006454:Hemoglobins; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron