Iron supplements helpful in anemic children with HIV

By David Douglas

Iron supplements had benefits for anemic children with HIV in Malawi, but they increased the risk of malaria and so prophylaxis may be needed, warn the authors of a recent study.

Although guidelines suggest using iron supplements in children at risk of deficiency, it's not known if the supplements are safe or helpful in kids with HIV, the research team said in a paper online August 15 in Clinical Infectious Diseases.

In a randomized trial, Dr. Kamija S. Phiri of the University of Malawi in Blantyre and colleagues studied 209 such children, aged six months to four years.

For three months, as treatment for mild anemia, the children took either 3 mg/kg/day of elemental iron and multi-vitamins, or multi-vitamins alone.

Part of the rationale, say the investigators, was that children in the placebo arm would at least be getting some benefit from the additional vitamins.

Ultimately, 196 children completed the three months of treatment and six months of follow-up. Iron supplementation was associated with greater increases in hemoglobin concentrations, with an adjusted mean difference (aMD) of 0.60 g/dL. Iron supplements also reduced the risk of anemia persisting during follow-up (adjusted prevalence ratio 0.59).

Immune function was also improved at three months, with a CD4 aMD of 6.0. There was no difference at six months, however.

In addition, these children had an increased incidence of malaria infection at six months, with an incidence rate of 120.2 versus 71.7. The adjusted incidence rate ratio was also elevated, particularly during the first three months. (In contrast, however, a new study in Ghana reported elsewhere today by Reuters Health, found that children who received nutrient powder with iron were no more likely to get malaria than their peers.)

Conversely, iron was protective against respiratory infections during the post-intervention period, a finding the researchers say "may be related to the mechanisms by which different pathogens derive iron from the body."

It is clear, they add, that "further studies are needed to unravel the complex, but interesting interaction between iron, immunity and infections in HIV-infected children."

Summing up, Dr. Phiri told Reuters Health by email, "This study addressed an important question about the benefit and safety of iron supplementation in HIV infected individuals. It has shown that in children, iron supplementation is clearly beneficial but must be given with adequate malaria prevention measures in areas where malaria is endemic."

SOURCE: http://bit.ly/17F9mmW

Clin Infect Dis 2013.