A prospective, cross sectional study of anaemia and peripheral iron status in antiretroviral naive, HIV-1 infected children in Cape Town, South Africa

Background Anaemia is a common manifestation of paediatric HIV infection. Although there are many causes, anaemia of chronic diseases is the most frequent type. In poor countries iron deficiency is widespread. It is probable that many HIV-infected children in these countries are also iron deficient. This study describes the relationship between paediatric HIV infection and anaemia, and documents the peripheral iron status of antiretroviral naive, HIV-infected children. Methods Sixty children were evaluated prospectively. Investigations included CD4+ count, haemoglobin concentration ( Hb), red blood cell ( RBC) morphology, and iron studies. Results Anaemia was present in 73%. Compared to mild HIV infection, median Hb was lower in children with moderate clinical infection ( 104 g/L v 112 g/L, p = 0.04) and se ere clinical infection ( 96 g/L v 112 g/L, p = 0.006), and more children with se ere infection were anaemic ( 92% v 58%, 0.04). There was a significant relationship between immunological status and Hb. Sixty eight per cent had abnormal RBC morphology. Significantly more children with moderate and se ere disease, and se ere immunosuppression had abnormal RBC morphology. Fifty two per cent were iron-depleted, 20% had iron-deficient erythropoiesis and 18% iron deficiency anaemia (IDA). 16% ( 7/44) of anaemic children had microcytosis and hypochromia. Median soluble transferrin receptor concentration was significantly higher in those with microcytic hypochromic anaemia (42.0 nmol/L v 30.0 nmol/L, p = 0.008). Conclusions Both the proportion of anaemic children and the median Hb were associated with disease status. Iron depletion and IDA are major problems in HIV-infected children in South Africa.