European Journal of Pediatrics

, Volume 171, Issue 3, pp 531–540

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

  • Anita Shet
  • Karthika Arumugam
  • Nirmala Rajagopalan
  • Chitra Dinakar
  • Shubha Krishnamurthy
  • Saurabh Mehta
  • Arun S. Shet
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

Authors and Affiliations

  • Anita Shet
    • 1
  • Karthika Arumugam
    • 2
  • Nirmala Rajagopalan
    • 3
  • Chitra Dinakar
    • 1
  • Shubha Krishnamurthy
    • 4
  • Saurabh Mehta
    • 5
  • Arun S. Shet
    • 6
  1. 1.Department of PediatricsSt. John’s National Academy of Health SciencesBangaloreIndia
  2. 2.Division of BiostatisticsSt. John’s National Academy of Health SciencesBangaloreIndia
  3. 3.Freedom FoundationBangaloreIndia
  4. 4.Infectious Diseases ClinicSt. John’s National Academy of Health SciencesBangaloreIndia
  5. 5.Division of Nutritional SciencesCornell UniversityIthacaUSA
  6. 6.Department of Hematology/OncologySt. John’s National Academy of Health SciencesBangaloreIndia