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

European Journal of Pediatrics volume 171, pages 531–540 (2012)Cite this article

Abstract

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.

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Fig. 1

Abbreviations

HIV:

Human immunodeficiency virus

ART:

Antiretroviral therapy

WHO:

World Health Organization

RDA:

Recommended dietary allowance

CRP:

C-reactive protein

sTfR:

Soluble transferrin receptor

sTfR/f:

Soluble transferrin receptor/log ferritin index

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Acknowledgments

The authors gratefully acknowledge the staff of the Pediatric and Infectious Diseases clinic at St. John’s Hospital for their assistance with patient care. The authors also thank the National AIDS Control Organization of India for its support to this work and for providing free ART for the patients. This work was partially supported by the International Nutrition Foundation/Ellison Medical Foundation Fellowship Award as well as the Child Health Foundation Grant awarded to AS.

The results of this study were presented in part at the World Public Health Nutrition Congress in Porto, Portugal, on 23–26 September, 2010.

Conflict of Interest

None

Author information

Affiliations

  1. Department of Pediatrics, St. John’s National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034, India

    Anita Shet & Chitra Dinakar

  2. Division of Biostatistics, St. John’s National Academy of Health Sciences, Bangalore, India

    Karthika Arumugam

  3. Freedom Foundation, Bangalore, India

    Nirmala Rajagopalan

  4. Infectious Diseases Clinic, St. John’s National Academy of Health Sciences, Bangalore, India

    Shubha Krishnamurthy

  5. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

    Saurabh Mehta

  6. Department of Hematology/Oncology, St. John’s National Academy of Health Sciences, Bangalore, India

    Arun S. Shet

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  1. Anita Shet
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  2. Karthika Arumugam
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Correspondence to Anita Shet.

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Shet, A., Arumugam, K., Rajagopalan, N. et al. The prevalence and etiology of anemia among HIV-infected children in India. Eur J Pediatr 171, 531–540 (2012). https://doi.org/10.1007/s00431-011-1599-y

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Keywords

  • HIV
  • Children
  • Anemia
  • Resource-limited
  • Anemia of inflammation
  • Iron
  • India