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Letter to the Editor

Published online by Cambridge University Press:  20 March 2012

Julia L. Finkelstein ,
Saurabh Mehta  and
Wafaie W. Fawzi
Julia L. Finkelstein*
Affiliation:
Division of Nutritional Sciences, Cornell University Savage Hall, Ithaca, NY 14853, USA
Saurabh Mehta
Affiliation:
Division of Nutritional Sciences, Cornell University Savage Hall, Ithaca, NY 14853, USA
Wafaie W. Fawzi
Affiliation:
Departments of Global Health and Population, Nutrition, and Epidemiology Harvard School of Public Health Boston, MA 02115, USA
*
*Corresponding author: Email jfinkelstein@cornell.edu
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Type
Letter to the Editor
Information
Public Health Nutrition , Volume 15 , Issue 7 , July 2012 , pp. 1328
Copyright
Copyright © The Authors 2012

HIV and iron-deficiency anaemia

Reply to ‘Predictors of HIV and iron-deficiency anaemia: a comment’

Madam

We read with interest the letter by Dr Wiwanitkit in reference to our recent article, ‘Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections( Reference Finkelstein, Mehta and Duggan 1 ).

We agree that anaemia and HIV should remain the focus of antenatal care providers, particularly in Sub-Saharan Africa. Anaemia is one of the most frequent haematological manifestations of HIV infection( Reference Firnhaber, Smeaton and Saukila 2 – Reference Levine, Berhane and Masri-Lavine 4 ), and the risk of anaemia may increase with HIV disease progression( Reference Volberding, Lagakos and Koch 5 ). Dr Wiwanitkit notes that ‘HIV does not increase the risk of anaemia among the pregnant’ based on a recent publication( Reference Oladeinde, Phil and Olley 6 ). In the cited cross-sectional study, however, HIV-infected individuals had a significant fivefold increase in the odds of being anaemic. A longitudinal cohort study with both HIV-infected and uninfected women may be more appropriate to examine this question.

We agree with Dr Wiwanitkit that the use of Hb and hypochromic microcytosis as the only indicators of Fe status is a study limitation, and have mentioned this in the paper's discussion section( Reference Finkelstein, Mehta and Duggan 1 ). In addition to Hb concentrations, serum ferritin and transferrin receptor, and at least one acute-phase protein, such as C-reactive protein or α-1 acid glycoprotein, would further improve Fe assessment in the context of inflammation and infection. With an average of nine Hb measurements per person (over 9000) collected prospectively at the time of the study, it was not possible to conduct a more detailed analysis of Fe status on all samples collected prospectively in the ancillary analysis( Reference Finkelstein, Mehta and Duggan 1 ). However, we previously published a detailed analysis of Fe status in the same cohort to examine the proportion of anaemia attributable to Fe deficiency among 584 HIV-infected women, including Hb, serum ferritin, serum transferrin receptor and C-reactive protein concentrations( Reference Kupka, Msamanga and Mugusi 7 ). Prevalence estimates were 39·7 % for Fe deficiency and 23·6 % for Fe-deficiency anaemia; 48·9 % of anaemia cases were associated with Fe deficiency( Reference Kupka, Msamanga and Mugusi 7 ).

References

1. Finkelstein, JL, Mehta, S, Duggan, CP et al. (2011) Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections. Public Health Nutr (Epublication ahead of print version).Google ScholarPubMed
2. Firnhaber, C, Smeaton, L, Saukila, N et al. (2010) Comparisons of anemia, thrombocytopenia, and neutropenia at initiation of HIV antiretroviral therapy in Africa, Asia, and the Americas. Int J Infect Dis 14, e1088–e1092.CrossRefGoogle ScholarPubMed
3. Sullivan, PS, Hanson, DL, Chu, SY et al. (1998) Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 91, 301–308.CrossRefGoogle ScholarPubMed
4. Levine, AM, Berhane, K, Masri-Lavine, L et al. (2001) Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J Acquir Immune Defic Syndr 26, 28–35.CrossRefGoogle Scholar
5. Volberding, PA, Lagakos, SW, Koch, MA et al. (1990) Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. N Engl J Med 322, 941–949.CrossRefGoogle Scholar
6. Oladeinde, BH, Phil, RM, Olley, M et al. (2011) Prevalence of HIV and anemia among pregnant women. North Am J Med Sci 3, 548–551.CrossRefGoogle ScholarPubMed
7. Kupka, R, Msamanga, GI, Mugusi, F et al. (2007) Iron status is an important cause of anemia in HIV-infected Tanzanian women but is not related to accelerated HIV disease progression. J Nutr 137, 2317–2323.CrossRefGoogle Scholar