Iron Status Is an Important Cause of Anemia in HIV-Infected Tanzanian Women but Is Not Related to Accelerated HIV Disease Progression

Anemia affects 2 billion people worldwide and is a serious public health problem (1). There are many potential causes of anemia, but iron deficiency (ID)7 is considered the major underlying nutritional factor. Nevertheless, it is difficult to quantify the contribution of ID to anemia. This is especially true in inflammatory conditions such as HIV disease, where proinflammatory cytokines induce an anemia of inflammation and alter biochemical indicators of iron status that are commonly used to diagnose

Based on a small number of studies, between 35 and 69% of HIV-infected pregnant women from sub-Saharan Africa, the geographic region most heavily affected by the HIVepidemic, are iron deficient (5–7). Although there are no studies to our knowledge in HIV-infected women of reproductive age, there is evidence based on HIV-untested women that the prevalence of ID may be similar to pregnant women. Furthermore, these studies indicate that more than one-half of anemia may be associated with ID (8,9). The paucity of studies on iron status in HIV-infected women in sub-Saharan Africa is an important research gap, as there is

evidence that ID (10), as well as elevated storage iron, may lead to adverse HIV-related outcomes. The potential risks of ID and high storage iron are of special relevance for treatment programs recommending supplemental iron for women of reproductive age (1). To expand the knowledge on iron status and its relation to anemia as well as HIV disease progression in sub-Saharan Africa, we conducted an observational study in HIVinfected women of childbearing age from Dar es Salaam, Tanzania.

Several studies evaluated the association between high iron status and adverse HIV-related outcomes in sub-Saharan Africa. Among HIV-infected pregnant women from Zimbabwe, those with severely depleted iron stores (SF ,6 mg/L) had only 0.27 times the viral load (95% CI ¼ 0.13,0.53) compared with participants with SF .24 mg/L (11), whereas in HIV-infected pregnant women from Malawi, sTfR and SF were not associated with CD4 cell count and viral load (42). In an evaluation from Kenya in 32 HIV-infected adults, 60 mg elemental iron given twice weekly for 4 mo did not affect viral load (43). Collectively, the available evidence indicates that among nonpregnant populations from developed countries, iron overload disorders occur and may lead to adverse HIV-related outcomes, possibly due to high exposure to iron for extended periods of time. The risk of iron overload appears to be lower in developing countries and less evidence links it to adverse outcomes. If you want to read full text you can download this