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Iron Supplementation in HIV-Infected Malawian Children With Anemia: A Double-Blind, Randomized, Controlled Trial

Esan, M. O., Boele van Hensbroek, Michael, Nkhoma, Ernest, Musicha, C., White, S. A., terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 and Phiri, K. S. (2013) 'Iron Supplementation in HIV-Infected Malawian Children With Anemia: A Double-Blind, Randomized, Controlled Trial'. Clinical Infectious Diseases, Vol 57, Issue 11, pp. 1626-1634.

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Abstract

Background. It is unknown whether iron supplementation in human immunodeficiency virus (HIV)–infected children living in regions with high infection pressure is safe or beneficial. A 2-arm, double-blind, randomized, controlled trial was conducted to examine the effects of iron supplementation on hemoglobin, HIV disease progression, and morbidity.

Methods. HIV-infected Malawian children aged 6–59 months with moderate anemia (hemoglobin level, 7.0–9.9 g/dL) were randomly assigned to receive 3 mg/kg/day of elemental iron and multivitamins (vitamins A, C, and D) or multivitamins alone for 3 months. Participants were followed for 6 months.

Results. A total of 209 children were randomly assigned to treatment, and 196 (93.8%) completed 6 months of follow-up. Iron supplementation was associated with greater increases in hemoglobin concentrations (adjusted mean difference [aMD], 0.60; 95% confidence interval [CI], .06–1.13; P = .03) and reduced the risk of anemia persisting for up to 6 months follow-up (adjusted prevalence ratio, 0.59; 95% CI, .38–.92; P = .02). Children who received iron had a better CD4 percentage response at 3 months (aMD, 6.00; 95% CI, 1.84–10.16; P = .005) but an increased incidence of malaria at 6 months (incidence rate, 120.2 vs 71.7; adjusted incidence rate ratio [aIRR], 1.81 [95% CI, 1.04–3.16]; P = .04), especially during the first 3 months (incidence rate, 78.1 vs 36.0; aIRR, 2.68 [95% CI, 1.08–6.63]; P = .03).

Conclusions. Iron supplementation in anemic HIV-infected children has beneficial effects on hemoglobin, anemia, and immunity but increases the risk of malaria. Thus, iron supplementation in HIV-infected children living in malaria-endemic areas should only be provided in combination with adequate protection from malaria.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/cit528
Depositing User: Martin Chapman
Date Deposited: 10 Mar 2014 15:35
Last Modified: 15 Jun 2018 14:41
URI: http://archive.lstmed.ac.uk/id/eprint/3611

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