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Community and International Nutrition

Iron Status Is an Important Cause of Anemia in HIV-Infected Tanzanian Women but Is Not Related to Accelerated HIV Disease Progression^1,2

Departments of ³ Nutrition and ⁴ Epidemiology, Harvard School of Public Health, Boston, MA, 02125 and ⁵ Departments of Community Health and ⁶ Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

^* To whom correspondence should be addressed. E-mail: rkupka{at}post.harvard.edu.

In HIV-infected populations from developing countries, it is unclear what proportion of anemia is attributable to iron deficiency (ID) and whether high body iron stores worsen HIV disease progression. We therefore evaluated these research questions in 584 HIV-infected Tanzanian women. Hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), and C-reactive protein (CRP) concentrations were evaluated between 13 and 43 wk after women gave birth. ID was defined as SF or sTfR outside normal ranges, and ID anemia (IDA) as ID plus low Hb. In multivariate Cox regression models, the association between SF and HIV disease progression was assessed. Participants received iron + folate supplements during pregnancy. Hb (r = –0.159; P = 0.0001), SF (r = 0.355; P < 0.0001), and sTfR/log SF index (r = –0.119; P = 0.004) were related to CRP, whereas sTfR (r = 0.029; P = 0.48) was not. Prevalence estimates were 39.7% for ID and 23.6% for IDA. ID was associated with 48.9% of anemia cases. Categories of SF were not significantly associated with HIV-related mortality or progression to stage 4. Nevertheless, SF > 150.0 µg/L was related to a nonsignificantly elevated risk of progression to stage 4 (rate ratio = 1.78; 95% CI = 0.68–4.64; P = 0.24) compared with SF < 12.0 µg/L. In HIV-infected, parous women from sub-Saharan Africa, ID is of moderately high prevalence and is an important underlying cause of anemia. High storage iron does not appear to be related to HIV disease progression in this population, but more research on the role of iron during HIV disease is needed.

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