European Journal of Pediatrics

, Volume 171, Issue 3, pp 531–540

The prevalence and etiology of anemia among HIV-infected children in India


    • Department of PediatricsSt. John’s National Academy of Health Sciences
  • Karthika Arumugam
    • Division of BiostatisticsSt. John’s National Academy of Health Sciences
  • Nirmala Rajagopalan
    • Freedom Foundation
  • Chitra Dinakar
    • Department of PediatricsSt. John’s National Academy of Health Sciences
  • Shubha Krishnamurthy
    • Infectious Diseases ClinicSt. John’s National Academy of Health Sciences
  • Saurabh Mehta
    • Division of Nutritional SciencesCornell University
  • Arun S. Shet
    • Department of Hematology/OncologySt. John’s National Academy of Health Sciences
Original Paper

DOI: 10.1007/s00431-011-1599-y

Cite this article as:
Shet, A., Arumugam, K., Rajagopalan, N. et al. Eur J Pediatr (2012) 171: 531. doi:10.1007/s00431-011-1599-y


In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2–12 years were prospectively enrolled in 2007–2008. Measured parameters included serum ferritin, vitamin B12, red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B12 deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18–26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score −2.5 vs. -1.9), stunted (height Z-score −2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p < 0.01), and higher log viral load (11.1 vs. 7.1, p < 0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p = 0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p < 0.01). Conclusion Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.


HIVChildrenAnemiaResource-limitedAnemia of inflammationIronIndia



Human immunodeficiency virus


Antiretroviral therapy


World Health Organization


Recommended dietary allowance


C-reactive protein


Soluble transferrin receptor


Soluble transferrin receptor/log ferritin index

Copyright information

© Springer-Verlag 2011