Iron supplementation for reducing morbidity and mortality in children with HIV

Adetifa I, Okomo U

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Summary

Giving iron supplements to improve outcomes in children with HIV/AIDS

Anaemia is one of the most common haematologic problem found in children with HIV/AIDS, second only to depletion of CD4/helper T lymphocytes. Anaemia in HIV-infected children can be caused by direct effects of HIV, other prevalent infections and opportunistic infections on blood producing cells; micronutrient deficiencies; or side effects of drugs used to prevent or treat opportunistic infections and HIV. Deficiency of iron, a micronutrient, is by far the most common cause of nutritional anaemia worldwide. Given the global prevalence of iron deficiency anaemia, especially in parts of the world where childhood HIV infections are quite prevalent, it is likely many HIV-infected children also are iron deficient. There is very little known, however, about the contribution of iron deficiency to anaemia observed in children with HIV/AIDS. Iron supplementation currently is given routinely to anaemic children in most of the developing countries where there also are high rates of HIV infection, and no obvious adverse effects have been observed. However, there are reports of a deleterious effect of iron supplementation during ongoing infections, including malaria. As iron deficiency and iron deficiency anaemia are common in HIV-infected children in high-prevalence areas with concerns about possible deleterious effects of iron, we looked for randomised clinical trials that demonstrated benefits or disadvantages of iron supplements, regardless of type or preparation. We did not find any such trials and conclude that there is a need for large multi-centre trials to examine these questions.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Adetifa I, Okomo U. Iron supplementation for reducing morbidity and mortality in children with HIV. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006736. DOI: 10.1002/14651858.CD006736.pub2.

This version first published online: January 21. 2009

Abstract

Background

The most prevalent haematologic disturbance associated with HIV in children (apart from CD4 lymphocytopenia) is anaemia. Anaemia associated with HIV arises from multiple mechanisms, including the direct inhibitory effect of HIV on red cell precursors, other locally prevalent and/or opportunistic infections, micronutrient deficiency, anaemia of chronic disease, and as a consequence of medicines given for HIV and/or other concurrent illnesses. Iron deficiency is the most common cause of nutritional anaemia globally. There is significant geographical overlap of areas of the world where iron deficiency anaemia (IDA) and paediatric HIV are distributed. Given the high prevalence of IDA, it is likely that many HIV-infected children also are iron deficient. The contribution of iron deficiency to anaemia in HIV-infected children has been described but is incompletely understood. Currently, iron supplementation for anaemic infants and children is routinely practiced without any obvious effect in most developing countries, which bear most of the burden of global paediatric HIV infections.

Because iron deficiency and IDA are common in HIV-infected children in high-prevalence areas and because there are concerns about possible deleterious effects of iron, this review aims to assess the evidence for iron supplementation for reducing morbidity and mortality in HIV-infected children.

Objectives

To determine whether iron supplementation improves clinical, immunologic, and virologic outcomes in children infected with HIV

Search strategy

We used the comprehensive search strategy developed specifically by the Cochrane HIV/AIDS Review Group to identify HIV/AIDS randomised controlled trials, and searched the following electronic databases: MEDLINE (searched November 2007); Embase (searched December 2007); and CENTRAL (December 2007). This search was supplemented with a search of AIDSearch (searched December 2007) and NLM Gateway (searched December 2007) to identify relevant conference abstracts, as well as a search of the reference lists of all eligible articles. The search was not limited by language or publication status.

Selection criteria

Randomised controlled trials (RCTs) of iron supplementation in any form and dose in HIV-infected children aged 12 years and younger.

Data collection and analysis

We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies.
No studies were identified that fulfilled the selection criteria.

Main results

No RCTs of iron supplementation in HIV-infected children were found.

Authors' conclusions

Implications for clinical practice:

The current clinical practice of iron supplementation in HIV-infected children is based on weak evidence comprising observational studies and expert opinions.

Implications for research:

High-quality RCTs of iron supplementation are urgently required, especially in areas with significant overlap of high prevalence of HIV, iron deficiency anaemia, and malaria. Policy makers should prioritise funding for these trials.

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