title: Minimal impact of an iron-fortified lipid-based nutrient supplement on Hb and iron status: a randomised controlled trial in malnourished HIV-positive African adults starting antiretroviral therapy.
abstract: Anaemia, redistribution of Fe, malnutrition and heightened systemic inflammation during HIV infection confer an increased risk of morbidity and mortality in HIV patients. We analysed information on Fe status and inflammation from a randomised, double blind, controlled phase-III clinical trial in Lusaka, Zambia and Mwanza, Tanzania. Malnourished patients (n 1815) were recruited at referral to antiretroviral therapy (ART) into a two-stage nutritional rehabilitation programme, randomised to receive a lipid-based nutrient supplement with or without added micronutrients. Fe was included in the intervention arm during the second stage, given from 2 to 6 weeks post-ART. Hb, serum C-reactive protein (CRP), serum ferritin and soluble transferrin receptor (sTfR) were measured at recruitment and 6 weeks post-ART. Multivariable linear regression models were used to assess the impact of the intervention, and the effect of reducing inflammation from recruitment to week 6 on Hb and Fe status. There was no effect of the intervention on Hb, serum ferritin, sTfR or serum CRP. A one-log decrease of serum CRP from recruitment to week 6 was associated with a 1.81 g/l increase in Hb (95% CI 0.85, 2.76; P< 0.001), and a 0.11 log decrease in serum ferritin (95% CI - 0.22, 0.03; P= 0.012) from recruitment to week 6. There was no association between the change in serum CRP and the change in sTfR over the same time period (P= 0.78). In malnourished, HIV-infected adults receiving dietary Fe, a reduction in inflammation in the early ART treatment period appears to be a precondition for recovery from anaemia.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,Keppel Street,LondonWC1E 7HT,UK.
authors.forename: Philip
authors.initials: P
authors.lastname: James
authors.affiliation: Department of Nutrition,Exercise and Sports, University of Copenhagen,Copenhagen,Denmark.
authors.forename: Henrik
authors.identifier: http://orcid.org/0000-0002-2848-2940
authors.initials: H
authors.lastname: Friis
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,Keppel Street,LondonWC1E 7HT,UK.
authors.forename: Susannah
authors.initials: S
authors.lastname: Woodd
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,Keppel Street,LondonWC1E 7HT,UK.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Rehman
authors.affiliation: Mwanza Research Centre, National Institute for Medical Research,Mwanza,Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: PrayGod
authors.affiliation: University Teaching Hospital,Lusaka,Zambia.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Vanderbilt Institute for Global Health,Nashville,TN,USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Koethe
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,Keppel Street,LondonWC1E 7HT,UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications / Q000178:diet therapy; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D005527:Food, Fortified; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000178:diet therapy; D007501:Iron / Q000378:metabolism; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage*; D008055:Lipids / Q000008:administration & dosage*; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy; D013636:Tanzania; D015024:Zambia
chemical_list: D044966:Anti-Retroviral Agents; D006454:Hemoglobins; D019266:Iron, Dietary; D008055:Lipids; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron
keywords: Antiretroviral therapy; Ferritin; HIV; Hb; Inflammation; Lipid-based nutrient supplement; Transferrin receptor